Background: Low- and middle-income countries (LMICs) are experiencing a nutrition transition that creates a paradoxical coexistence of undernutrition and overnutrition. While stunting remains a persistent public health problem, rates of childhood overweight, obesity, and diabetes are rapidly increasing. Pediatric diabetes, including both type 1 (T1D) and type 2 (T2D), poses a growing threat to child health and healthcare systems that are already strained.Type 1 diabetes has historically been underdiagnosed in LMICs, with many children presenting late and experiencing preventable morbidity or mortality due to lack of insulin access. Meanwhile, rising obesity rates are driving type 2 diabetes in children, a condition once rare in pediatrics but now increasingly reported in Asia, Africa, and Latin America. The coexistence of stunting and obesity illustrates the “double burden of malnutrition,” complicating efforts to achieve optimal growth and prevent noncommunicable diseases.Objective: To review recent evidence on the burden, challenges, and opportunities in addressing pediatric diabetes in LMICs, with a focus on the intersection between stunting, obesity, and early-onset diabetes.Method: A narrative mini-review was conducted using PubMed, WHO, International Diabetes Federation (IDF), and UNICEF reports. Literature published between 2010 and 2024 was reviewed with priority to pediatric studies and public health analyses from LMICs. Search terms included pediatric diabetes, type 1 diabetes, type 2 diabetes, stunting, obesity, nutrition transition, low- and middle-income countries.Results: Epidemiology: Incidence of T1D is rising worldwide, but LMIC data are limited due to weak surveillance. Many children present with diabetic ketoacidosis at diagnosis. T2D in children, once rare, is emerging as a major concern, with prevalence increasing in urban LMIC settings.Access to care: Insulin remains unaffordable or unavailable in many regions, while glucose monitoring tools are scarce. Pediatric endocrinologists are concentrated in tertiary centers, leaving large rural populations underserved.Nutrition transition: Increased intake of sugar-sweetened beverages and ultra-processed foods contributes to childhood obesity and insulin resistance, even as undernutrition persists in rural and disadvantaged communities.Double burden: Stunted children are at greater risk of metabolic complications when exposed to obesogenic diets, potentially accelerating T2D onset.Innovations: Mobile health tools, community-based peer support, and low-cost diagnostic strategies are being piloted to bridge gaps in LMIC contexts.Discussion: The emerging epidemic of pediatric diabetes in LMICs underscores the complexity of malnutrition in the 21st century. Stunting and obesity are not separate phenomena but interlinked stages of a broader nutritional crisis. Addressing pediatric diabetes requires integrating noncommunicable disease prevention into child health and nutrition programs, strengthening surveillance, and ensuring equitable access to insulin and diagnostic tools.Conclusion: Pediatric diabetes is an under-recognized but growing burden in LMICs, fueled by both stunting and obesity. Strategies to combat this double burden must prioritize early detection, affordable care, and policies that promote healthier food environments. Investing in pediatric diabetes care today is critical to prevent lifelong health consequences for the next generation.
