Objective  To assess the changes in the disease burden and risk factors of type 2 diabetes mellitus (T2DM) globally and in China from 1990 to 2021 and predict their future trends.

Methods  Based on the Global Burden of Disease 2021 database, the age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized disability-adjusted life years (DALY) rate (ASDR), age-standardized mortality rate (ASMR), and their estimated annual percentage changes (EAPC) were used to analyze the disease burden of T2DM globally and in China from 1990 to 2021. The auto-regressive integrated moving average model (ARIMA) was applied to predict trends in disease burden.

Results  From 1990 to 2021, the global T2DM ASIR [EAPC=1.74%, 95%CI (1.72%, 1.76%)], ASPR [EAPC=2.12%, 95%CI (2.08%, 2.16%)], ASMR [EAPC=0.21%, 95%CI (0.15%, 0.27%)] and ASDR [EAPC=1.04%, 95%CI (1.00%, 1.08%)] showed increasing trends. In China, T2DM ASIR [EAPC=1.10%, 95%CI (1.01%, 1.19%)], ASPR [EAPC=1.65%, 95%CI (1.56%, 1.75%)], and ASDR [EAPC=0.69%, 95%CI (0.54%, 0.84%)] showed an upward trend, while ASMR [EAPC=-0.22%, 95%CI (-0.49%, 0.04%)] showed no significant change. The prevalence, DALY rate, and mortality of T2DM among the elderly were higher than those among young and middle-aged adults globally and in China, while the incidence rate among individuals aged 15 to 24 is notably elevated. Globally and in China, all four rates were higher in males than in females. From 1990 to 2021, high fasting plasma glucose and high body mass index (BMI) remained the top two risk factors for T2DM-related deaths globally and in China, while environmental particulate matter pollution showed the largest rise in ranking among risk factors. It is projected that by 2040, the global and China T2DM ASIR will rise to 385.85/100,000 and 305.10/100,000, respectively; ASPR to 8,619.18/100,000 and 7,509.98/100,000, respectively; ASDR to 975.50/100,000 person years and 636.63/100,000 person years, respectively; global ASMR will increase to 18.83/100,000, while China’s ASMR will decrease to 8.64/100,000.

Conclusion  The disease burden of T2DM was heavier in males and the elderly, and the onset age tended to be younger among adolescents. High fasting plasma glucose and high BMI were important risk factors for T2DM-related deaths globally and in China. China has achieved notable results in prevention and control, but the predicted disease burden remains severe. It is necessary to strengthen the three-level prevention strategy and strictly control relevant risk factors.

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