Diabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic
stroke, affecting up to a third of individuals with
cerebrovascular diseases. Beyond being a risk factor for
stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic
stroke. Hyperglycaemia during the acute
ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive
glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic
stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of
sodium-glucose cotransporter 2 inhibitors and
glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with
heart failure and
chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute
stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments.