Prediabetes has the same pathophysiology as T2D but is associated with lower plasma glucose than in T2D. The prevalence of diagnosed diabetes among US adults is 9%.249 Prediabetes and diabetes are asso- ciated with increased risk for first ischemic stroke (RR, Prediabetes is pres- ent in 30% of patients with acute ischemic stroke255 and is associated with increased risk for recurrence.256 Progression of prediabetes to T2D can be prevented by maintaining a healthy weight, exercising, eating a healthy diet, and taking certain medications.237,238,245 T2D is also present in 30% of patients with ischemic and is associated with increased risk for recur- rence (RR, 1.6).209,257 Remission of established T2D can be achieved by weight loss,258 260 although no tri- als have established that weight loss or diabetes remis- sion reduces risk for recurrent stroke. Recent clinical trials demonstrated that at least 1 drug in each of the 3 classes of glucose-lowering medications can reduce risk for MACEs in patients with T2D and established ath- erosclerotic vascular disease, including ischemic stroke or high risk: thiazolidinediones, glucagon-like protein 1 (GLP-1) receptor agonist, and sodium-glucose cotrans- porter 2 inhibitor. Unlike the data for the thiazolidinedi- one pioglitazone and some GLP-1 receptor agonists, the cardiovascular outcome trials of sodium-glucose cotransporter 2 inhibitors do not suggest a specific effect on stroke but rather on cardiovascular death, MI, and heart failure.261 Recommendation-Specific Supportive Text 1. Intensive control of blood sugar for patients with both type 1 diabetes and T2D has been shown to reduce risk for microvascular complications, includ- ing retinopathy, nephropathy, and peripheral neu- ropathy. 