Abdominal aortic aneurysm (AAA) is a life-threatening disease, associated with high rates of mortality in case of aortic rupture. While the disease is often associated with atherosclerosis and cardiovascular risk factors, the majority of epidemiological studies published so far have highlighted a negative association between diabetes and AAA. However, a recent publication from epidemiological data of the National Health Fund in Poland reported a higher incidence of AAA and rupture in diabetic patients compared to non-diabetics. Here, we discuss issues and methodological considerations hoping to shed light on these unexpected results.