Objective To analyze the disease burden and future trends of chronic kidney disease attributable to type 2 diabetes mellitus (CKD-T2DM) among the elderly population globally and in China from 1990 to 2021, and to generate evidence to inform public health strategies and clinical decisions. Methods Data on the burden of CKD-T2DM among individuals aged ≥60 years globally and in China between 1990 and 2021 were obtained from the Global Burden of Disease 2021 database. The Joinpoint regression was employed to calculate the average annual percentage change (AAPC) of age-standardized prevalence rate and age-standardized disability-adjusted life years rate (ASDR), in order to assess temporal trends of the disease burden. The Bayesian age-period-cohort model was applied to project the number of prevalent cases and disability-adjusted life years (DALYs) associated with CKD-T2DM among the elderly population globally and in China from 2022 to 2035. Results Compared with 1990, the number of CKD-T2DM elderly cases globally and in China, including both males and females, increased significantly by 2021. However, the age-standardized prevalence rate demonstrated a significant decline from 1990 to 2021 (both AAPC<0, P<0.001). Similarly, the number of DALYs attributable to CKD-T2DM among the elderly in China also increased, whereas the ASDR showed a statistically significant decrease only among the overall and females’ populations during 1990-2021 (both AAPC<0, P<0.001). Globally, the number of DALYs also increased substantially, and the ASDR exhibited a significant overall upward trend from 1990 to 2021 across all groups (overall, male, and female populations; both AAPC>0, P<0.001). The age group with the most pronounced increase in prevalent cases was 65-69 years, whereas the highest increase in DALYs was observed in the 70-74 age group both globally and in China. Decomposition analysis indicated that population growth was the primary driver of increases in both the number of prevalent cases and DALYs attributable to CKD-T2DM among older adults across all regions. According to Bayesian age-period-cohort projections, the number of prevalent cases and DALYs associated with CKD-T2DM among the elderly is expected to continue increasing globally and in China from 2022 to 2035, with a more pronounced increase anticipated in China compared to the global trend. Conclusions The burden of CKD-T2DM among the elderly remains substantial both globally and in China, and is projected to increase in the coming years. There is an urgent need to develop and implement effective public health policies and targeted disease management strategies to mitigate its growing challenges.