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AIMS Emerging evidence suggests that platelet count predicts the development of type 2 diabetes, however, there is conflicting evidence concerning the relationship in men and women. This study aimed to assess the longitudinal association between platelet count and incidence risk of type 2 diabetes. MATERIALS AND METHODS Among 10,030 total participants, 7,325 participants (3,439 men and 3,886 women) without diabetes were selected from the Korean Genome and Epidemiology Study. Platelet count quartiles were divided as follows: Q1 ≤219, Q2, 220-254, Q3, 255-296 and Q4 ≥297 (x103 /ml) for men and ≤232, 233-266, 267-305 and ≥306 (x103 /μL) for women. The hazard ratios (HRs) with 95% confidential intervals (CIs) for incident type 2 diabetes were calculated using multiple Cox proportional hazards regression models according to sex-specific platelet count quartiles. RESULTS During the biennial follow-up period from 2001-2002 to 2013-2014, 750 male participants (21.8%, 750/3,439) and 730 female participants (18.8 %, 730/3,886) had newly developed type 2 diabetes. For women, compared to the reference first quartile, the HRs for incident type 2 diabetes in the second, third, and fourth platelet count quartiles were 1.20 (0.96-1.50), 1.21(0.97-1.51), and 1.47 (1.18-1.82) after adjusting for age, body mass index, smoking status, alcohol intake, physical activity, mean arterial blood pressure, family history of diabetes, and HOMA-IR. However, these positive relationships were not observed in men after adjusting for the same co-variables. CONCLUSIONS Platelet count was independently associated with an increased risk of incident type 2 diabetes only in women. This article is protected by copyright. All rights reserved.