Challenges in Pediatric Diabetes Classification: A Case Report

•Pediatric type 2 diabetes mellitus incidence and prevalence are increasing.•Classifying pediatric diabetes types is difficult due to their overlapping features.•Accurate diagnosis is critical to optimize outcomes for patients.•Children aged > 10 years or postpubertal should be screened.•Maturity-onset diabetes of the young should be considered in the differential. Type 2 diabetes (T2DM) incidence and prevalence are increasing in pediatrics. All children aged > 10 years or postpubertal should be screened in primary care for T2DM if they are overweight with one risk factor or have signs of insulin resistance or associated conditions. Classifying pediatric diabetes is challenging. An accurate, timely diagnosis is critical to optimize care, as children with T2DM are at risk for more severe disease as adults. We describe a 10-year-old female referred to endocrine following abnormal laboratory results in primary care. Despite the initial presentation of diabetic ketoacidosis, the child was diagnosed with T2DM.