Background:
The prevalence of type 2 diabetes mellitus (T2DM) has increased in the United States, contributing significantly to morbidity and mortality.

Objectives:
This study analyzes trends in T2DM-related mortality focusing on demographic and regional disparities.

Methods:
The CDC WONDER database was utilized to extract death certificate data for adults aged 25 and older from 1999 to 2023. Age-adjusted mortality rates (AAMRs) per 100,000 persons were calculated. Temporal trends were assessed by calculating the annual percent change (APC) using Joinpoint regression analysis.

Results:
From 1999 to 2023, a total of 2,031,626 deaths were attributed to T2DM in the United States. The AAMR more than doubled from 21.54 per 100,000 in 1999 to 53.95 per 100,000 in 2023 with a pronounced increase between 2018 and 2021 (AAMR: 62.7 in 2021, APC: 16.06%; 95% CI: 11.84 to 19.66). Males had considerably higher AAMR than females (68.82 vs 42.48 in 2023). Among racial and ethnic groups, Hispanic or Latino populations had the highest AAMR in 2023 (69.69), followed by non-Hispanic Black or African American (65.45), non-Hispanic other populations (53.7), and non-Hispanic white group (49.98). The Western region of the United States showed the highest AAMR (78.29), and rural areas consistently had
higher mortality rates compared to urban areas (69.88 vs 55.32 in 2020). From 1999 to 2023, cardiovascular disease accounted for 626,706 deaths among adults with T2DM.

Conclusion:
T2DM-related mortality has increased substantially over the time in US, with a peak observed between 2018 and 2021, emphasizing the need for targeted interventions.