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Background Diabetes is associated with increased hospital complications and mortality following trauma. However, there is limited research on the longer-term recovery of trauma patients with diabetes. The aim of this study was to explore the association between type 2 diabetes (T2D) and in-hospital and 24-month outcomes in major trauma patients. Methods In this cohort study using the Victorian State Trauma Registry, middle-aged and older adults (≥ 45 years) with major trauma were followed up at 24-months post injury. Logistic regression (univariable and multivariable) analyses were used to determine the association between diabetes status and 24-month patient-reported outcomes. In-hospital outcomes were compared between groups using chi-square tests. Results Of the 11,490 participants who survived to hospital discharge, 8,493 survived to 24-months post-injury and were followed-up at that time point: 953 people (11%) with and 7540 (89%) without T2D. People with T2D had a higher in-hospital death rate (19%) compared to people without T2D (16%), p < 0.001. After adjusting for confounders, people with T2D had poorer outcomes 24-months post injury than people without T2D, with respect to functional recovery (Extended Glasgow Outcome Scale) (adjusted odds ratio [AOR] [95% CI]: 0.58 [0.48, 0.69]) and return to work/study (AOR [95% CI]: 0.51 [0.37, 0.71]). People with T2D experienced higher odds of problems with mobility (AOR [95% CI]: 1.92 [1.60, 2.30]), self-care (AOR [95% CI]: 1.94 [1.64, 2.29]), usual activities (AOR [95% CI]: 1.50 [1.26, 1.79]), pain and discomfort (AOR [95% CI]: 1.75 [1.49, 2.07]), anxiety and depression (AOR [95% CI]: 1.45 [1.24, 1.70]), and self-reported disability (AOR [95% CI]: 1.51 [1.28, 1.79]) than people without T2D. Conclusions Major trauma patients with T2D have a poorer prognosis than patients without T2D, both during their hospital admission and 24-months post-injury. Patients with T2D may need additional health care and support following trauma to reach their recovery potential.