Knowledge Gaps and Future Research Having T2D is one of the most prevalent risk factors for future stroke after an initial acute ischemic stroke or TIA. It is a promising target for secondary prevention because diabetes remission can be achieved in many patients through weight management and vascular protection can be achieved by newer glucose-lowering agents. In addi- tion, diabetes is associated with CNS small vessel dis- ease and vascular dementia. Potential areas of research include the following: It is plausible that interventions for prediabetes, established diabetes, and glucose management will reduce risk for neurocognitive outcomes and subclinical ischemic damage and discrete stroke events. The IRIS trial demonstrated that 1 glu- cose-lowering intervention, pioglitazone, prevented CLINICAL STATEMENTS AND GUIDELINES Kleindorfer stroke and MI in patients with insulin resistance without diabetes. The benefit of other interventions for prediabetes, including GLP-1 receptor agonists, dietary improvement, and weight reduction, has not been investigated but would logically follow from the IRIS trial. The same interventions could be examined in patients with established diabetes. Some early investigations have explored the effec- tiveness of poststroke behavioral counseling and physical training, modeled on cardiac rehabilitation, for improving lifestyle after stroke. Because diabetes disproportionately affects Black and Hispanic communities, effective commu- nity-based research for diabetes prevention and management may yield interventions to reduce dis- parities in stroke risk and recovery. Because patients with ischemic stroke or TIA tend to be older and to have established vascu- lar disease, the optimal goal for glycemic control remains uncertain. In this regard, however, some professional organizations recommend targeting reduce the risk for hypoglycemia in elderly indi- viduals with limited life expectancy or significant Recommendations for Obesity Referenced studies that support recommendations are summarized in online Data Supplements 16 and 17. 