Type 2 diabetes (T2D) was once considered a disease of adults. However, the obesity pandemic has helped its transition to the pediatric population. While type 1 diabetes remains the most common type of pediatric diabetes in Canada, the incidence of youth-onset T2D has increased by 60% in recent years. Canada has one of the highest prevalences of youth-onset T2D in the world, with approximately 50% of new cases annually occurring in Indigenous children, with the remaining 50% of cases occurring in other ethnic groups, including Caucasians. As a relatively new disease in youth, there is a lack of natural history data for youth-onset T2D to predict long-term outcomes. However, its aggressive nature in youth suggests that these patients will likely have a significant burden of disease related to cardiometabolic risk, comorbidities, and complications. In this paper, we highlight current knowledge on the pathophysiology of youth-onset T2D, diagnostic criteria, the impact of obesity on diabetes risk, comorbidities and complications, and current treatments.