Stroke is one of the atherosclerotic cardiovascular diseases that are the leading cause of morbidity and mortality for people with type 2 diabetes (T2DM) and are the largest contributor to the direct and indirect costs of T2MD. Despite improvements in the management of type T2MD, the implementation level of these preventive interventions and treatment for T2MD complications is still suboptimal. Substantial opportunity exists to further improve diabetes control to prevent primary stroke and improve early management to reduce stroke related morbidity, mortality, and cost. We will first validate a new stroke microsimulation model for T2DM that reflects the modern paradigm of diabetes progression, stroke management, and treatment. This model will then be used to evaluate the cost-effectiveness of enhanced levels of implementing seven primary prevention strategies and expanding the current acute ischemic stroke treatment guideline to include selected wake-up stroke patients based on perfusion imaging for stroke in T2DM patients from a national perspective. The results of the evaluation will advance scientific knowledge and will have major implications for health policies for stroke prevention and treatments in type 2 diabetes patients.