Objective To analyze the prevalence, disease burden, and trends of diabetes in China from 1999 to 2019, providing reference for diabetes prevention and control as well as health resource allocation to alleviate the disease burden. Methods Data on the disease burden of diabetes in China from 1999 to 2019 were collected from the Global Burden of Disease (GBD) 2019 database. Indicators such as incidence rate, prevalence rate, mortality rate, disability-adjusted life years (DALYs), years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs) were used to analyze the diabetes burden in China by gender, age and year. The estimated annual percentage change (EAPC) was used to measure the temporal trend of standardized rates over a specified period, and the rank sum test was used to assess the gender differences in disease burden. Results In 2019, 3.78×10⁶ cases of diabetes and 1.73×10⁵ deaths were reported in China. Compared with 1999, the standardized rates of incidence and prevalence increased by 5.80% and 17.12%, respectively, while the standardized mortality rate decreased by 2.82%. Compared with 1999, the standardized rates of DALYs and YLDs increased by 2.86% and 16.06%, respectively, while the standardized YLL rate decreased by 14.39%. The EAPC for diabetes incidence, prevalence, YLDs, and DALYs in the 20-40 age group all exceed 0, indicating an annually upward trend in disease burden of diabetes. Additionally, the disease burden in males was significantly higher than that in females (P<0.05), and the gap is continuously widening. Conclusions The disease burden of diabetes in China is severe, particularly in term of life loss due to disability. The population with diabetes onset is becoming increasingly younger. Males constitute a high-risk population for diabetes-related morbidity and mortality. Diabetes prevention and control efforts should continue to enhance behavioral interventions, appropriately tilt health resource allocation towards high-risk population, and focus on improving the rehabilitation capabilities and promoting rehabilitation technology at grass-roots unit.