Three decades of CKD due to diabetes mellitus type 2 in China, with projections of disease burden from 2022 to 2036: a systematic analysis for the Global Burden of Disease Study 2021

Background A comprehensive assessment of disease burden is critical for optimizing management strategies for chronic kidney disease (CKD) due to type 2 diabetes (T2DM) in China. This study analyzes 30-year trends (1990–2021) in T2DM-related CKD burden, epidemiological characteristics, 15-year projections, and dietary risk factors in China. Methods Data from the Global Burden of Disease Study (GBD) were used to examine prevalence, incidence, deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) stratified by age, sex, and year. Analytical methods included joinpoint regression to identify trend changes, age-period-cohort modeling to disentangle demographic effects, decomposition analysis to assess drivers (aging, population growth, epidemiological shifts), ARIMA forecasting for 2022–2036 projections, and dietary risk factor analysis focusing on seven modifiable dietary factors. Results From 1990 to 2021, T2DM-related CKD burden showed a consistent upward trend. In 2021, prevalence reached 20.91 million cases (age-standardized rate [ASR]: 1 053.92/100 000), a 75.87% increase from 1990. Incidence and mortality rose by 177.64% and 147.26%, respectively, with 354 000 new cases and 108 000 deaths. Males exhibited higher ASRs than females across all outcomes, and the 70–94 age group bore the highest burden. Aging was the primary driver of burden growth. Projections (2022–2036) indicate declining age-standardized prevalence but rising trends in incidence, mortality, DALYs, and YLLs, with stable YLDs. Key dietary risks included high red meat consumption and low intake of whole grains and fruits. Conclusions While age-standardized rates for some outcomes may decline, absolute burdens of T2DM-related CKD in China are increasing, driven by population aging. Strengthening healthcare systems, enhancing risk factor screening (e.g. dietary interventions), and improving diabetes management are imperative for prevention and control.