Genome-wide association studies (GWAS) have consistently implicated noncoding variation within the TCF7L2 locus with type 2 diabetes (T2D) risk. While this locus represents the strongest genetic determinant for T2D risk in humans, it remains unclear how these noncoding variants affect disease etiology. To test the hypothesis that the T2D-associated interval harbors cis-regulatory elements controlling TCF7L2 expression, we conducted in vivo transgenic reporter assays to characterize the TCF7L2 regulatory landscape. We found that the 92-kb genomic interval associated with T2D harbors longrange enhancers regulating various aspects of the spatial-temporal expression patterns of TCF7L2, including expression in tissues involved in the control of glucose homeostasis. By selectively deleting this interval, we establish a critical role for these enhancers in robust TCF7L2 expression. To further determine whether variation in Tcf7l2 expression may lead to diabetes, we developed a Tcf7l2 copy-number allelic series in mice. We show that a null Tcf7l2 allele leads, in a dosedependent manner, to lower glycemic profiles. Tcf7l2 null mice also display enhanced glucose tolerance coupled to significantly lowered insulin levels, suggesting that these mice are protected against T2D. Confirming these observations, transgenic mice harboring multiple Tcf7l2 copies and overexpressing this gene display reciprocal phenotypes, including glucose intolerance. These results directly demonstrate that Tcf7l2 plays a role in regulating glucose tolerance, suggesting that overexpression of this gene is associated with increased risk of T2D. These data highlight the role of enhancer elements as mediators of T2D risk in humans, strengthening the evidence that variation in cis-regulatory elements may be a paradigm for genetic predispositions to common disease.[Supplemental material is available for this article.]Recent GWAS have uncovered a number of loci affecting risk of T2D (Voight et al. 2010). While some of these loci include genes known to play a role in glucose metabolism and diabetes pathogenesis (PPARG, KCNJ11) (Willson et al. 2001;Gloyn et al. 2006), others represent genomic regions with unknown functional roles in disease etiology. Among these, a set of single nucleotide polymorphisms (SNPs) on chromosome 10q25.2 shows strong and consistent association with T2D in virtually every population tested, constituting the greatest effect on risk identified to date, with a cumulative allelic odds ratio of 1.46 (Grant et al. 2006;Cauchi et al. 2007;Lyssenko 2008). These SNPs map to a 92-kb interval within TCF7L2, a gene encoding a transcription factor of the canonical Wnt signaling pathway known to have developmental roles in determining cell fate, survival, proliferation, and movement (Moon et al. 2004;Clevers 2006;MacDonald et al. 2009). Given the complexity of this pathway, establishing a definitive role for TCF7L2 in the etiology of T2D has been challenging (Pearson 2009).While the TCF7L2 T2D-associated interval spans coding sequence, exonic v...