The co-management of diabetes and liver diseases is important and challenging. We aimed to evaluate the deaths and disability-adjusted life years (DALYs) burden of liver cancer combined with high fasting plasma glucose (LC-HFPG) from different perspectives.

We forecasted age-standardized death (ASDR) and DALYs rates (ASDALYR) to 2035 and calculated average annual percent changes (AAPC) during 2005-2021 and 2022-2035. We also conducted health inequality, frontier and decomposition analysis.

The deaths and DALYs of LC-HFPG doubled from 2005 to 2021. ASDR and ASDALYR of LC-HFPG increased during 2005-2021 and is projected to increase to 2035 for males. LC-HFPG burden was heavier in males than in females. The ASDR and ASDALYR in low-middle SDI quintile always increased the fastest during 2005-2021 and 2022-2035. The highest ASDR and ASDALYR had changed from African Region in 2005 into Eastern Mediterranean Region (EMR) in 2021. The ASDR and ASDALYR increased in all WHO regions, except for Western Pacific Region (WPR). EMR always have the fastest increase of ASDR and ASDALYR. WPR always had the highest deaths and DALYs of LC-HFPG. The lowest deaths and DALYs had shifted from the EMR in 2005 to African region in 2021. The increase in deaths and DALYs mainly depends on epidemiologic changes and population growth. Among the five most populous countries, Brazil is projected to achieve the lowest ASDR and ASDALYR of LC-HFPG, while USA has much room to improve. The analysis of health inequality indicates that the deaths and DALYs inequality of LC-HFPG worldwide is decreasing and is trending towards equality.

ASDR and ASDALYR of LC-HFPG increased globally, especially in EMR. Brazil has achieved the lowest ASDR and ASDALYR of LC-HFPG, while USA has much room to improve, which provide support for policy-making. The mortality and DALYs inequality of LC-HFPG worldwide is decreasing and is trending towards equality. The elderly and middle-aged people are the main group affected by LC-HFPG. Our research highlights the necessity of formulating targeted prevention and treatment strategies for different regions, which should be able to meet the specific needs of different populations, especially in countries with low SDI and high SDI.