Global burden, trends and forecast analysis of early-onset type 2 diabetes and diabetes-related chronic kidney disease: a global burden of disease 2021 analysis

Background: Early-onset type 2 diabetes mellitus (T2DM) and consequent diabetic chronic kidney disease (CKD-T2DM) pose significant global public health challenges. This study aims to systematically analyze the disease burden, risk factors, and regional disparities of T2DM and CKD-T2DM among the global population aged 15–39 years from 1990 to 2021, and to predict the epidemic trends from 2022 to 2036. Method: Based on the Global Burden of Disease (GBD) database, this study analyzed the disability-adjusted life years (DALYs) of T2DM and CKD-T2DM, along with their corresponding age-standardized rates (ASRs) and risk factors, for the global and regional populations aged 15-39 years from 1990 to 2021. Joinpoint regression was used to calculate the average annual percentage change (AAPC), while the age-period-cohort (APC) model was applied to analyze age, period, and cohort effects. Decomposition analysis identified drivers of changes in disease burden, and the autoregressive integrated moving average model was employed to forecast the trends from 2022 to 2036. Outcome: From 1990 to 2021, the global burden of early-onset T2DM increased significantly, with an absolute burden rise of 165.50% and an age-standardized disability-adjusted life-year rate (ASDR) increases of 86.26%. in contrast, CKD-T2DM exhibited a 29.66% absolute burden increase, whereas its ASDR declined by 19.61%. When stratified by the socio-demographic index (SDI), high-SDI regions exhibited the fastest growth rates in ASDR for both T2DM and CKD-T2DM (2.75% and 0.52%, respectively), while moderate-SDI regions bore the heaviest absolute disease burden (DALYs of 943,543 and 73,954, respectively). Additionally, the burden of T2DM and CKD-T2DM is primarily driven by high body mass index (BMI), which accounted for 57.21% and 51.34% of their respective burdens in 2021. Conclusion: The divergent trends between early-onset T2DM (increasing burden) and CKD-T2DM (stable ASDR) necessitate distinct public health approaches. With high BMI driving more than 50% of the burden, anti-obesity interventions are paramount. Notably, metabolic surgery, which can induce sustained glycemic control and mitigate CKD progression in relevant patients, warrants inclusion in this strategy. Therefore, focusing on obesity prevention and precision management in younger and middle-aged groups is crucial to alleviating the future burden.