Diabetes mellitus is among the most costly individual and economic burdens on children, families, and healthcare systems (1). With a prevalence of about 1 per 1,000 children for type I and 1 per 500 children for type II diabetes mellitus, it is estimated that acute care for diabetes in the pediatric population tops $25 billion per year in the United States, and $250 billion for the entire US population (1). The long-term costs of childhood diabetes are orders of magnitude greater than this amount, as the complications of diabetes become manifest in adulthood as an increased burden of cardiovascular and metabolic disease, compounded in those individuals with poor compliance (2).

In the United States and worldwide, the incidence of type I and type II diabetes mellitus is increasing. For type I diabetes, we are seeing a shift to earlier onset of disease (3). For type II diabetes, the rise in incidence more than outpaces the rise in rates of obesity (4). The changing incidence of diabetes has been linked to ethnic, social, economic, and cultural factors, which need to be considered in developing programs for the care of children with diabetes mellitus. The report by Gandhi and coauthors in the current issue of Pediatric Research (5), highlights the challenges of diabetes care for immigrant populations in the United States, where these factors intersect to influence disease course and management.

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