Insulin-requiring diabetes was associated with a higher risk of ischemic stroke/TIA/systemic embolism (1.81%/year) vs both no diabetes (HR 2.10, 95% CI 1.31–3.38; p = 0.002) and diabetes not on insulin (HR 2.06, 95% CI 1.18–3.62; p = 0.014). Here, INS is linked to ischemic stroke.