T2D in childhood continues to increase worldwide and is associated with significant lifetime morbidity and the early development of complications, including retinopathy, neuropathy, and nephropathy. A disproportionate number of affected children reside in Manitoba, Canada. In 2010-2011, the annual incidence rate of childhood-onset T2D was 25 per 100,000 children in Manitoba, 20-fold higher than in other provinces across Canada. The First Nation people in Manitoba have the highest reported incidence of T2D in children in the world, with rates up to 400/100,000 children. A private polymorphism in the First Nation population, HNF1α G319S, is an important risk factor found in approximately 42% of the children with T2D in our province. Our community knowledge users, patient and parent advisory committee and stakeholder advisory committee have identified the early detection of children at risk of T2D, the determination of modifiable pathways in the natural history of childhood T2D, and focused community based intervention programming as research health priorities for the DREAM (Diabetes Envisioned and Accomplished in Manitoba) clinical and basic science research group at the Children’s Hospital Research Institute of Manitoba (CHRIM). The Next Generation Cohort is a unique First Nations prospective birth cohort designed to address these research priorities by examining metabolic and anthropometric outcomes of offspring born to mothers or fathers diagnosed in childhood with T2D. To date, 226 children of 78 mothers with T2D and 18 fathers with T2D have been enrolled in the cohort. This talk will describe the Canadian experience of type 2 diabetes in children including findings from the Next Generation birth cohort study.