Type 2 diabetes mellitus (T2DM) among children is a growing national and international public health concern with a complex pathophysiology involving genetic and epigenetic risk factors, as well as social and environmental risk factors. The increasing incidence of T2DM in youth disproportionately affects non-white racial and ethnic groups. The more aggressive pathogenic nature of T2DM compared to that of adults necessitates further investigation of the heterogeneity of disease pathophysiology. Moreover, a better understanding of the genetic architecture of T2DM in youth, with a focus on diversity of the populations we study, is an important step towards precision medicine. This review highlights recent advances in understanding the genetic architecture of T2DM in children and discusses potential barriers and future needs for investigation, with a particular lens on health equity.