Preconception counseling has been a public health dilemma for many years as industrialized nations try to reconcile their fortitude in medicine with their poor pregnancy outcomes. Prior to the Center for Disease Controls (CDC) national recommendations in 2006, survey data showed that many providers were not addressing this stage in a womens life. Only 1 of 6 Primary Care Providers in the United States provided preconception care for women prior to their prenatal care. This problem is further complicated by chronic diseases that are now appearing in women of reproductive age. Globally, diabetes will increase by more than 50% in the next 10 years. This has translated into a 76% increase in prevalence among women in the last 25 years. However, this proportional increase has not translated into better care. This paper will summarize the need for preconception care for the Type 2 diabetic woman, look at challenges in the first trimester, and offer a literature review of the clinical guidelines for the primary care provider, obstetrician, and the endocrinologist.