Objective To explore the efficacy and safety of intravenous hormone combined with compre⁃ hensive treatment in patients with severe acute exacerbation of chronic obstructive pulmonary disease（AECOPD） complicated with type 2 diabetes mellitus（T2DM）. Methods Out of 131 screened patients，a total of 122 patients were included in the study，and 9 patients dropped out due to compliance issues. Patients were randomly divided into two groups，and receiving intravenous glucocorticoid（observation group，n = 67）or oral hormone（control group，n = 55）. Outcome measures including therapeutic efficacy，inflammatory factor levels，pulmonary function and glucose levels and adverse events were evaluated. Results The effective rate between two groups was differ⁃ ent，and the observation group（97.0%）was higher than that of the control group（87.3%），the difference was sta⁃ tistically significant（P < 0.05）. The length of hospital stay in the observation group was shorter［（11.2 ± 2.0）vs. （14.1 ± 2.2）days］，with statistically significant differences（P < 0.001）. At discharge，compared with the control group，the levels of inflammatory cytokines in the observation group were significantly decreased［IL⁃1β：（58.32 ± 6.53）vs.（41.34 ± 4.97）pg/mL；IL⁃18：（412.47 ± 44.48）vs.（321.43 ± 34.69）pg/mL；PCT：（0.067 ± 0.006） vs.（0.042 ± 0.012）ng/mL；hs⁃CRP：（10.86 ± 0.77）vs.（7.32 ± 0.89）mg/L］，the differences were statisticallysignificant（p values were < 0.001，< 0.001，0.019 and < 0.001，respectively＝. The indexes of pulmonary ventila⁃ tion function were improved［FEV1：（1.88 ± 0.67）vs.（2.74 ± 0.51）L；FEV1/FVC（%）：PEF（L/S）（2.08 ± 0.37）vs.（2.67 ± 0.47）］，the differences were statistically significant（ALL P < 0.001）. At 3⁃month follow⁃up， there were no significant differences in glucose metabolism indexes between the two groups，observation group vs. control group：［Fasting blood glucose：（7.89 ± 1.19）vs.（7.97 ± 0.95）mmol/L，P = 0.249；HbA1c（%）：（7.13 ± 0.88） vs.（7.02 ± 0.82），P = 0.076］. However，insulin dosage in the observation group（84.42 ± 3.22）U was higher than that in the control group（50.61 ± 2.84）U，and the difference was statistically significant（P < 0.001. No significant difference in the incidence rate of adverse reactions was noted during treatment（P > 0.05）. Conclusions Compared with oral hormone，intravenous hormone was more effective in patients with severe AECOPD complicated with T2DM，which improved pulmonary ventilation function，increased blood oxygen level，shortened hospital stay，and avoided worsening blood glucose with the simultaneous use of insulin.