In the last decade, diabetes has nearly doubled in the United States. It has become one of the most prevalent diseases in North Carolina and the nation. According to the NC Department of Health and Human Services, it is the fifth leading cause of death in the state. More than a half million people have diabetes in North Carolina. Though type 2 diabetes was at one time fairly rare among young adults and adolescents, it is now commonplace in pediatric populations and a major concern of public health agencies and child care physicians throughout our state. Diabetes is costly. Nationally, the estimated cost of direct medical care for each person with diabetes is twice that of a person without the disease. In North Carolina diabetes related costs exceed 1.5 billion dollars a year.