For low- and middle-income countries, where 3 out of 4 people with diabetes now live, the human and financial costs threaten to overwhelm health systems and undermine national economic progress. To date, the focus of diabetes prevention has been placed on lifestyle interventions to modify adult behaviour, particularly obesity related unhealthy diets and physical inactivity. But a compelling body of evidence now indicates that many of the risks leading to type 2 diabetes originate in the very early stages of life, influenced by maternal under or over-nutrition, diabetes in the mother and the fetal and post-natal environment.