Background: Diabetes mellitus is a known risk factor for stroke and may be linked to poorer poststroke outcomes. However, the underlying molecular mechanisms remain to be fully identified. In this study, we assessed the association of long noncoding RNA (lncRNA) nuclear-enriched abundant transcript 1 (NEAT1) expression and its target microRNA (miRNA)-124 with acute ischemic stroke (AIS) in type II diabetes mellitus patients. Methods and Results: Diabetic patients with stroke, nondiabetics with stroke, diabetics without stroke, and controls were selected. NEAT1 and miR-124 expression in plasma samples from research participants was investigated by a real-time reverse transcription-quantitative polymerase chain reaction. C reactive protein (CRP) and Tumor necrosis factor (TNF-a) were measured using an enzyme-linked immunosorbent assay technique. In the diabetes mellitus (DM)+AIS group, NEAT1 expression was considerably higher, in comparison with AIS group and with control group. In comparison to the AIS patients, DM patients, and the control, miR-124 expression was considerably lower in the DM+AIS group. NEAT1 demonstrated a good predictive value for AIS risk in diabetics, according to receiver operating characteristic curve. In both, the DM+AIS and AIS group, NEAT1 level was strongly linked with the National Institutes of Health Stroke Scale (NIHSS) score. Also, significant positive correlation was observed between NEAT1 expression and inflammatory markers CRP and TNF-a and significant negative association with miRNA-124 in patient groups. Conclusion: NEAT1 expression could be used a as diagnostic marker of stroke in diabetic patients. In diabetic patients, the lncRNA NEAT1 may influence the incidence, severity, inflammation, and prognosis of AIS