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Introduction: Numerous studies have shown a paradoxically protective effect of diabetes on development and progression of abdominal aortic aneurysm (AAA). The aim of our study was to investigate whether the protective role of diabetes on abdominal aortic aneurysms extends to rupture. Methods: Register-based case-control study of patients with a ruptured AAA (RAAA) matched 1:1 with patients undergoing elective surgery for AAA by sex, year of birth, and year of diagnosis. Multiple conditional logistic regression to estimate the odds ratio (OR) associating a diagnosis of diabetes with RAAA. Results: From 1996 to 2016, we found 6,932 eligible people with RAAA. We excluded 640 people diagnosed with RAAA who did not undergo any surgery and were alive after 30 days. Furthermore, we excluded 898 people with an RAAA since we could not match them with the eligible controls. This left us with 5,394 cases in our study. The cases had a median age of 75 and 85.4% were men. Comparing cases with controls and the presence of diabetes, we found a crude OR of 0.79 (CI 0.62-0.92). When adjusting for confounders, OR increased to 0.96 (CI 0.82-1.12). Stratifying by sex, age, and year of diagnosis did not changed the results markedly. OR for having RAAA and diabetes was higher in women, but this was not statistically significant in the adjusted analysis, OR 1.51 (CI 0.99-2.34). Of the 5,394 cases, the 30-days mortality was 58% (n¼3,144). Using logistic regression, we found a crude OR of 1.14 (CI 0.91-1.41) of dying within 30 days and having diabetes compared to no diabetes. Adjusting for index year, male sex, age, and the use of statins, we found an adjusted OR of 1.29 (CI 1.02-1.63) of dying within 30 days and having diabetes. Conclusion: We were not able to demonstrate a protective effect of diabetes on RAAA compared with elective AAA. We found, however, an increased risk of dying within 30 days of RAAA with the presence of diabetes.