To systematically assess the disease burden of ischemic stroke (IS) attributable to high fasting plasma glucose (HFPG) among Chinese adults aged 25 years and older from 1990 to 2021 based on 2021 Global Burden of Disease (GBD) data, and to analyze population disparities and project trends for 2022 to 2035, providing evidence for prevention and control strategies.

Data were extracted from the GBD 2021 database, including age-standardized mortality rate (ASMR), disability-adjusted life years per million (ASDR), and population subgroup data for HFPG-related IS in China from 1990 to 2021. Joinpoint regression model was used to analyze temporal trends, and Bayesian age-period-cohort (BAPC) model was employed to predict future burden changes.

Overall, both the ASMR and ASDR for HFPG-related IS showed a declining trend from 1990 to 2021 among individuals aged 25 and older in China. However, in 2021, the ASMR (19.76 per 100 000) and ASDR (354.37 per 100 000 person-years) remained significantly higher than the global levels (ASMR=14.69 per 100 000; ASDR=266.36 per 100 000 person-years). The disease burden was higher in males than in females, with an increasing trend among those aged 25 to 44 years and a non-significant decline among those aged 80 years and older. Projections indicated that China’s ASMR and ASDR will be in a continuous decline from 2022 to 2035, with a projected rate of decrease exceeding the global average, though absolute levels will still remain higher than the global average.

Although the overall burden of HFPG-related is among Chinese individuals aged ≥25 years has decreased, the prevention and control situation remains severe. Countermeasures　It is recommended to enhance blood glucose screening for high-risk populations and standardized primary care management. Precise intervention strategies should be formulated for males, the elderly, and other young high-risk groups. Additionally, it is essential to improve the continuum of stroke treatment, rehabilitation services, and medical insurance coverage, while establishing a monitoring, evaluation, and early warning system to curb the burden of hyperglycemia-related ischemic stroke.