Diabetes mellitus represents one of the most significant public health challenges facing the USA-Mexico border region, where prevalence rates are 2-3 times higher than national averages. This dissertation provides the first comprehensive, multidimensional analysis of diabetes burden across all ten border states, integrating historical trends (1990-2021), spatial patterns (2018-2023), and future projections (2022-2030). Using data from the Global Burden of Disease Study 2021, CDC WONDER, and Mexican national statistics, we employ trend analysis, spatial autocorrelation, and multi-model forecasting to characterize the diabetes epidemic across this binational corridor. Our historical analysis reveals a profound epidemiological paradox: while disease occurrence has converged between Mexican and USA border states (prevalence: 9,010 vs 8,298 per 100,000; incidence: 435 vs 426 per 100,000), mortality outcomes remain dramatically divergent. Mexican border states experience nearly five-fold higher mortality (67.2 vs 12.0 per 100,000) and three times higher disability-adjusted life years (DALYs: 2,355 vs 896 per 100,000), representing "epidemiological failure" where healthcare systems cannot prevent fatal complications despite detecting disease. Our spatial analysis identifies "epidemiologic cliffs" at the international border where adjacent communities experience up to six-fold mortality differences. High-Low spatial clusters concentrate precisely at the USA-Mexico boundary (Moran's I = 0.454, p<0.001), demonstrating that healthcare system factors override shared genetic ancestry, environmental exposures, and lifestyle patterns in determining outcomes. Our forecasting analysis projects 30-50% increases in diabetes burden by 2030, with approximately 23,000-26,000 annual deaths, 15-17 million people with diabetes, and 1.6-1.8 million DALYs. However, trajectories diverge markedly: Mexican border states face accelerating working-age mortality (ages 20-59: +15-58%), while USA border states show declining mortality but dramatic youth prevalence increases (age <20: +35-52%). These findings demand urgent binational responses: Mexican states require immediate mortality prevention through expanded treatment access and medication affordability, while USA states must prepare for rising youth prevalence through school-based screening and pediatric endocrinology capacity. The methodological frameworks developed provide transferable approaches for studying other diseases characterized by binational disparities.