Glycemic abnormalities including prediabetes and Type 2 diabetes mellitus (T2DM) are emerging clinical problems in children and adolescents. Increased insulin resistance during pubertal development appears to uncover glycemic abnormalities. Pediatricians and physicians should be knowledgeable and conscious about the prevalence and progression of prediabetes to T2DM, the frequent mild or asymptomatic manifestation of T2DM in children and adolescents and the high risk of complications in these patients. Screening for glycemic abnormalities seems useful in high risk groups such as children and adolescents with obesity, family history of T2DM, and with clinical features suggestive of insulin resistance (hypertension, dyslipidemia, polycystic ovarian syndrome, or acanthosis nigricans). Modification of life style and reduction of obesity is still the prime target of prevention and early management of early glycemic abnormalities. However, use of hypoglycemic drugs is indicated when these measures fail to achieve adequate glycemic control.