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Type 2 diabetes mellitus is a common disease among adults. According to recent estimates, 7.9% of US adults ≥ 18 years of age have diabetes, with type 2 diabetes representing [...], Background. In 2000, the American Diabetes Association issued recommendations for type 2 diabetes mellitus screening among children. They recommended testing children ≥ 10 years of age who have a body mass index (BMI) of >85th percentile for age and at least 2 other risk factors (family history of type 2 diabetes, high-risk race/ethnicity, or evidence of insulin resistance, such as acanthosis nigricans). Objective. To describe the application of a type 2 diabetes mellitus screening protocol in an urban pediatric clinic. Design/Methods. Medical records for patients 10 to 18 years of age who were examined in health maintenance visits during a 13-month period were reviewed; 997 subjects were included in the analyses. Data collected included demographic features, medical history, family history, physical examination findings, dietary and physical activity counseling, and results of laboratory tests. BMI percentiles for age were determined from national references. Results. Subjects were 50% male (median age: 13.2 years), 96% Hispanic, and 48% (n = 477) had a >85th percentile BMI (including 26% with a ≥ 95th percentile BMI). Of the 477 subjects, 100% were in high-risk racial/ ethnic groups, 29% had a family history of diabetes, and 20% demonstrated evidence of insulin resistance; 194 (41%) met the criteria for screening. Of those who met the criteria, 38% (n = 73) had screening ordered and 65 of those subjects (89%) completed screening. Acanthosis nigricans was more common among subjects for whom screening was ordered (69%), compared with subjects who were not screened (3%). Three screened subjects exhibited impaired glucose tolerance; none had overt diabetes. Subjects for whom screening was ordered were more likely to have received counseling than were subjects not recognized as qualifying for screening (84% vs 52%). Conclusions. At this high-risk clinical site, the American Diabetes Association type 2 diabetes screening protocol was inconsistently applied. Acanthosis uigricans was a driving factor in identification and screening. Recognition of the need for screening was associated with a higher rate of documentation of nutritional counseling. Additional evaluation of the effectiveness of screening protocols in the early identification of diabetes and the effects of screening protocols on long-term morbidity is needed. Pediatrics 2004;114:141-148; child overweight, type 2 diabetes, screening, primary care. ABBREVIATIONS. BMI, body mass index; OW, overweight; AROW, at risk for overweight; ADA, American Diabetes Association; OGTT, oral glucose tolerance test; FPG, fasting plasma glucose; PCOS, polycystic ovary syndrome; IWS, Infant Welfare Society.