OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation in the airways causing airway obstruction. COPD exacerbations are commonly treated with corticosteroids as it decreases inflammation in the airways. Our objective is to assess the association between corticosteroid exposure and the incidence of T2D in a COPD commercial claims population. METHODS: We conducted a retrospective case control study of a US commercial claims data set. We analyze 33.14 million members for potential inclusion in the COPD cohort, who were continuously eligible during a 1-year study period. Beneficiaries with at least 1-year of continuous enrollment and evidence of >2 COPD-related claims were included in the study. Cases were defined as a beneficiary with a new claim for T2D, whereas controls lacked evidence of T2D. Cases and controls were matched on their propensity to have a new claim for T2D using the Greedy matching algorithm. Amount of corticosteroid exposure was assessed from the first T2D claim or matched healthcare event in controls to the first claim for COPD. RESULTS:  Of 18,829 COPD patients, 2,097 patients had incident T2D. Differences between the groups included significantly higher congestive heart failure, Peri-Vascular disorder, Paralysis, Other neurological disorders, Renal failure, Liver disease, Peptic ulcer with no bleed, Coagulopathy, Obesity, Blood loss anemia, Deficiency anemia, and Depression. After matching, 2,790 beneficiaries were assigned to cases (n=1,395) and controls (n=1,395). Cases had statistically higher rate of injected corticosteroid exposure (3.57 grams/day) (p=<0.001). There were no statistical differences in the rate of inhaled and oral corticosteroid exposure. CONCLUSIONS:  Our findings suggest that corticosteroid exposure, injected, for COPD exacerbations may contribute to the development of T2D. This demonstrates the need for constant revision of corticosteroid dose in patients with COPD, to ensure that the minimally sufficient dose is used, together with the review of the appropriate response to therapy.