Type 2 diabetes is a multifactorial disease influenced by genetics, environment, health behaviors, and social determinants. It is the 4th leading cause of death due to its association with heart attacks and strokes. In 2010, 8.3% of Americans had diagnosed diabetes, while an additional 5.1% had undiagnosed diabetes. Rates are increasing in children and adolescents, especially among minorities. In Virginia, the diabetes prevalence was 8.7% in 2011 but is estimated to be 13.8% when including undiagnosed cases. Prevalence is higher in Appalachian Virginia where residents have lower education and income levels. Efforts to address diabetes include national targets, standards of care,