East Asia and high-income Asia Pacific burden of diabetes mellitus from 1990 to 2023.

Diabetes mellitus (DM) remains a major health challenge in East Asia and the high-income Asia Pacific, yet systematic subtype-specific comparisons are lacking. Using Global Burden of Disease Study 2023 data, we analyzed age-standardized incidence, prevalence, mortality, and disability-adjusted life year (DALY) rates for DM subtypes from 1990 to 2023, calculated mortality-to-incidence ratios (MIRs) and population-attributable fractions, and projected outcomes to 2050. In 2023, East Asia had higher MIR (0.04) and mortality (8.26/100,000) than the high-income Asia Pacific (0.02 and 4.50/100,000), with type 2 diabetes (T2DM) comprising >94% of cases. High body-mass index was the primary T2DM risk factor (49.3%); T1DM burden was linked to temperature exposure. Under the reference scenario, T2DM mortality and DALY rates will rise by 2050, but optimized behavioral and metabolic interventions could reduce DM DALY rates by >84% in East Asia and >70% in the high-income Asia Pacific, highlighting the urgent need for targeted, risk-factor-specific diabetes control strategies.