Context: There is concern that the growing incidence of pediatric type 2 diabetes (T2D) may have been further exacerbated by the COVID-19 pandemic. Objective: To examine whether trends in new-onset pediatric T2D - inclusive of patients requiring hospitalization and patients managed as outpatients - were impacted during the COVID-19 pandemic, and to compare patient characteristics prior to and during COVID-19. Methods: A retrospective single-center medical record review was conducted in a hospital which cares for 90% of Alabama's pediatric T2D patients. Patients with new-onset T2D referred from March 2017 to March 2021 were included. Counts of patients presenting per month ("monthly rates") were computed. Linear regression models were estimated for the full sample and stratified by Medicaid and non-Medicaid insurance status. Patient characteristics prior to vs during COVID-19 were compared. Results: A total of 642 patients presented with new-onset T2D over this period. Monthly rates were 11.1±3.8 prior to COVID-19 and 19.3±7.8 during COVID-19 (P=.004). Monthly rates for Medicaid patients differed prior to and during COVID-19 (7.9±3.4 vs 15.3±6.6, P=.003) but not for non-Medicaid patients (3.3±1.7 vs 4.0±2.4, P=.33). Regression results showed significant increases in monthly rates during COVID-19 for the full sample (β= 5.93, P<.05) and for Medicaid enrollees (β= 5.42, P<.05) Hospitalization rate, severity of obesity, and hemoglobin A1c remained similar prior to and during COVID-19, though the proportion of male patients increased from 36.8% to 46.1% (P=.021). Conclusions: A rise in new-onset T2D was observed among Alabama's youth during the COVID-19 pandemic, a burden that disproportionately affected Medicaid enrollees and males. Future research should explore the pathways through which the pandemic impacted pediatric T2D.