The prevalence of diabetes has been increasing substantially each year. Thus, diabetes has become one of the most important risk factors for incident and recurrent ischemic strokes. The risk conferred by diabetes is higher for diabetic patients who are less than age 65 and is proportionally higher in race-ethnic minorities where diabetes prevalence is higher than for Caucasians. To reduce risk of ischemic stroke, a structured program that addresses all of the diabetes-associated risk factors of the metabolic syndrome is likely to be most effective. Diabetes increases poststroke mortality and adversely affects poststroke outcomes as compared with stroke patients without diabetes. Further research is needed to clarify optimal ways of reducing mortality and improving outcomes.