To analyze the trends of diabetes burden and Quality of Care Index (QCI) in China from 1990 to 2023.

Data on diabetes incidence, prevalence and mortality were extracted. The estimated annual percentage change (EAPC) was used to evaluate the burden trends. QCI was constructed using principal component analysis. Differences in QCI by age, sex and diabetes type were compared. Long-term temporal trends in QCI from 1990 to 2023 were further analyzed.

The total prevalence and age-standardized incidence increased significantly (EAPC=0.79%, 95%CI: 0.62%-0.97%), while age-standardized mortality decreased significantly (EAPC=-0.68%, 95%CI: -0.87%- -0.48%). Trends in type 2 diabetes mellitus (T2DM) were consistent with the overall pattern. The first principal component explained 86.0% of the total variance. QCI generally decreased with age, with no statistically significant sex difference. QCI differed significantly among type 1 diabetes mellitus (T1DM), T2DM and overall diabetes (adjusted P<0.001). During the period from 1990 to 2023, T1DM demonstrated a consistent gradual decline in QCI; in contrast, T2DM displayed an initial decline followed by a subsequent increase.

The prevalence burden of diabetes in China continues to increase, while mortality risk has decreased. Quality of care varies by diabetes type and age. Targeted optimization of diabetes care resource allocation is needed in the future, with emphasis on the extreme age groups and improvement of care quality for patients with T1DM.