Data are presented comparing-non-insulin dependent diabetes mellitus (NIDDM) and insulin dependent diabetes mellitus (IDDM) in youth. Children and adolescents with NIDDM were predominantly Mexican-American, presented less frequently in ketoacidosis, had a greater frequency of family history of diabetes, had higher BMIs (27.4 vs 16.6 kg/m(2)), and had higher frequency of acanthosis nigricans (67% vs 1.2%), Logistical, social, and cultural challenges facing the physician creating children and adolescents with NIDDM are discussed, and treatment options for NIDDM in youth are briefly reviewed.