he prevalence of type 2 diabetes in children is increasing worldwide. 1-3 In 2006-2008, the incidence of childhood-onset type 2 diabetes in Canada was estimated at 1.54 per 100 000 per year, with the highest incidence in Manitoba (12.45 per 100 000 per year); in Ontario, the incidence was 1.7 per 100 000 per year. 4 First Nations children in Canada have the highest incidence of type 2 diabetes, at 23.2 per 100 000 per year. 4 In Manitoba and northwestern Ontario, 87% of children with type 2 diabetes have First Nations heritage. 5 First Nations status and exposure to diabetes in utero are independently associated with an increased risk of type 2 diabetes in the first 30 years of life. 6,7 This is especially concerning because youth with type 2 diabetes experience complications sooner than youth with type 1 diabetes. 8,9 The prevalence, incidence and outcomes of diabetes among First Nations children in Ontario are not known. It is important for First Nations communities to have these data to inform population approaches to prevent and manage diabetes