The Veterans Health Administration (VHA) is the largest integrated health system in the United States, serving 9 million veterans.15 Veterans with IBD frequently have risk factors predisposing them to both corticosteroid and anti-TNF agent adverse effects, including older age, tobacco use, and comorbidities, such as coronary artery disease, hypertension, hyperlipidemia, and diabetes.7,16,17 We aimed to examine the hypothesis that anti-TNF therapy is associated with reduced mortality relative to prolonged corticosteroid use in an established cohort of veterans with IBD. This evidence concerns the gene TNF and diabetes mellitus.