Type 2 diabetic nephropathy (T2DN) is a major chronic complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage kidney disease and cardiovascular disease. It imposes a substantial disease burden on patients and society, representing a growing global public health challenge.

This study aims to analyze the trends in the disease burden of T2DN in China using data from the Global Burden of Disease (GBD), and predict its trajectory to 2050, thus providing evidence for public health policies and prevention and control strategies.

Data on T2DN in China from 1990 to 2021 were extracted from the GBD 2021, including incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates. The estimated annual percentage change (EAPC) was used to evaluate the trends of these indicators by sex and age groups. The autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were employed for time-series forecasting. Model prediction accuracy was assessed using the absolute percentage error (APE) .

From 1990 to 2021, the age-standardized incidence rate of T2DN in China showed an increasing trend (EAPC=0.42%, 95%CI=0.34% to 0.50%), while the age-standardized prevalence rate (EAPC=-0.24%, 95%CI=-0.39% to -0.10%), DALY rate (EAPC=-0.70%, 95%CI=-0.80% to -0.60%), and mortality rate (EAPC=-0.57%, 95%CI=-0.66% to-0.49%) showed decreasing trends. Stratified by sex, the increase in age-standardized incidence was greater in females (EAPC=0.6%, 95%CI=0.49% to 0.71%) than in males (EAPC=0.23%, 95%CI=0.17% to 0.29%). The decrease in age-standardized prevalence was more pronounced in males (EAPC=-0.27%, 95%CI=-0.41% to -0.13%) than in females (EAPC=-0.22%, 95%CI=-0.37% to -0.07%). Age-standardized DALY and mortality rates decreased significantly in females (DALY rate EAPC=-1.13%, 95%CI=-1.25% to -1.02%; mortality EAPC=-1.10%, 95%CI=-1.20% to -1.01%), with smaller changes observed in males (DALY rate EAPC=-0.28%, 95%CI=-0.40% to -0.15%; mortality EAPC=-0.06%, 95%CI=-0.19% to 0.08%). Age-specific analysis revealed that all disease burden indicators increased with age, with a heavy burden on the elderly, and incidence and DALY rates showed an upward trend in some older age groups. The ARIMA model predicted that by 2050, the male age-standardized incidence rate, prevalence, DALY rate and mortality rate were predicted to be 27.34/100 000, 877.11/100 000, 140.79/100 000, and 7.64/100 000, respectively. For females, the age-standardized rates were predicted to be 18.17/100 000 (incidence), 938.24/100 000 (prevalence), 69.66/100 000 (DALYs), and 4.77/100 000 (mortality). The ES model predicted that by 2050, male age-standardized rates would be 19.57/100 000 (incidence), 1 055.85/100 000 (prevalence), 140.38/100 000 (DALYs), and 7.30/100 000 (mortality). For females, the age-standardized rates were predicted to be 16.49/100 000 (incidence), 1 092.09/100 000 (prevalence), 105.84/100 000 (DALYs), and 5.16/100 000 (mortality). Model error assessment showed that the ES model had smaller errors for most age-standardized rates and prevalence cases, while the ARIMA model had relatively smaller errors for some case number indicators and the female age-standardized mortality rate.

From 1990 to 2021, the overall age-standardized disease burden of T2DN in China improved, particularly in the mortality and DALY rates. However, the age-standardized incidence rate continued to rise, with an increasingly evident trend of the disease burden concentrating in the elderly population. This study predicts that new cases in China will continue to increase until 2050. Therefore, precision prevention and control strategies targeting high-risk groups (especially the elderly and males) should be developed, and the core role of general practice in chronic disease management must be strengthened to address future public health challenges.

2型糖尿病肾病（T2DN）是2型糖尿病的主要慢性并发症之一，也是导致终末期肾病和心血管疾病的重要原因，给患者和社会带来沉重的疾病负担，已成为全球日益严峻的公共卫生挑战。

本研究旨在基于全球疾病负担数据，分析中国T2DN疾病负担的变化趋势，预测T2DN至2050年的发展趋势，为T2DN防控和公共卫生政策提供数据支持。

本研究以2021年全球疾病负担数据库（GBD 2021）为数据来源，提取1990—2021年中国T2DN的发病率、患病率、伤残调整生命年率（DALY率）和死亡率和作为评估T2DN疾病负担的指标。采用年度百分比变化估计值（EAPC）评估这些指标在不同性别和年龄组的变化趋势。采用自回归积分滑动平均（ARIMA）模型和指数平滑（ES）模型分别对不同性别和年龄组的各指标进行时间序列预测，并通过绝对百分比误差（APE）评估模型预测误差。

1990—2021年，中国T2DN的年龄标准化发病率呈上升趋势（EAPC=0.42%，95%CI=0.34%~0.50%）；年龄标准化患病率呈轻微下降趋势（EAPC=-0.24%，95%CI=-0.39%~-0.10%）；年龄标准化DALY率呈轻微下降趋势（EAPC=-0.7%，95%CI=-0.8%~-0.6%）；年龄标准化死亡率呈下降趋势（EAPC=-0.57%，95%CI=-0.66%~-0.49%）。按性别划分，女性年龄标准化发病率上升幅度相对较大（EAPC=0.6%，95%CI=0.49%~0.71%），男性上升幅度较小（EAPC=0.23%，95%CI=0.17%~0.29%）；男性年龄标准化患病率下降幅度较女性更为明显（男性EAPC=-0.27%，95%CI=-0.41%~-0.13%；女性EAPC=-0.22%，95%CI=-0.37%~-0.07%）；女性年龄标准化DALY率和死亡率呈显著下降趋势（DALY率EAPC=-1.13%，95%CI=-1.25%~-1.02%；死亡率EAPC=-1.10%，95%CI=-1.20%~-1.01%），男性变化较小（DALY率EAPC=-0.28%，95%CI=-0.40%~-0.15%；死亡率EAPC= -0.06%，95%CI=-0.19%~0.08%）。年龄别分析显示，各项疾病负担指标均随年龄增长而升高，高龄人群负担沉重，且部分高年龄组发病率和DALY率呈上升趋势。ARIMA模型预测结果显示，2050年男性年龄标准化发病率增至27.34/10万，患病率降至877.11/10万，DALY率保持在140.79/10万，死亡率保持在7.64/10万。女性年龄标准化发病率增至18.17/10万，患病率降至938.24/10万，DALY率降至69.66/10万，死亡率保持在4.77/10万。ES模型预测结果显示，2050年男性的年龄标准化发病率增至19.57/10万，患病率降至1 055.85/10万，DALY率降至140.38/10万，死亡率保持在7.30/10万；女性的年龄标准化发病率增至16.49/10万，患病率增至1 092.09/10万，DALY率降至105.84/10万，死亡率降至5.16/10万。模型误差评估显示，ES模型在大多数年龄标准化率和患病人数的预测上误差较小，而ARIMA模型在部分人数指标和女性年龄标准化死亡率上误差相对较小。

1990—2021年，中国T2DN的整体疾病负担在年龄标准化后有所改善，尤其在死亡率和DALY率方面，但年龄标准化发病率持续上升，且疾病负担向高龄人群集中的趋势日益明显。本研究预测至2050年，中国新发病例仍将持续增加。应制定针对高风险人群，尤其是针对高龄人群和男性的精准防控策略，加强全科医学在慢病管理中的核心作用，以应对未来的公共卫生挑战。