Background <p>Our study examines changes in the nationwide prevalence of US childhood T2D in the 0–5 age group category between 2016 and 2020.</p> Methods <p>We used five years of NSCH data on children aged 0–17 years and isolated data from the subgroup of children aged 0–5 years for a focused analysis on early childhood T2D. Survey questions were selected for two independent variables, dietary factors and physical activity factors. The dependent variable, T2D severity, was based on parental reporting of whether the child was diagnosed with T2D by their healthcare provider, status of disease, and the severity of the condition. Means, proportions, and chi-square tests were used to compare the frequency of dietary and physical activity factors by T2D severity classification.</p> Results <p>In 2016 and 2020, childhood T2D was significantly associated with the presence of a library in the child’s neighborhood. In 2017, it was also associated with access to free or reduced cost meals. For the early childhood subgroup, significant associations occurred in 2016 for receiving neighbor help and in 2019 regarding walkability levels in the child’s neighborhood.</p> Conclusions <p>Programs designed to prevent diabetes in children should address broader issues of food access and food quality.</p> Impact <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Childhood diabetes prevention programs should address broader issues of food access and quality.</p> </ItemContent> <ItemContent> <p>Research is needed on early childhood Type II diabetes behavioral and environmental risk factors.</p> </ItemContent> <ItemContent> <p>Our study provides exploratory estimates of change in the nationwide prevalence of US childhood T2D.</p> </ItemContent> </UnorderedList></p>