Background and purposeStudies showed that -cell dysfunction is associated with increased risk of cardiovascular disease and subclinical carotid atherosclerosis. This study aimed to investigate the association between -cell function and prognosis of non-diabetic patients with ischaemic stroke. MethodsIschaemic stroke patients without diabetes in the Abnormal Glucose Regulation in Patients with Acute Stroke across China registry were included in this analysis. Homeostasis assessment of -cell function (HOMA-) was performed and classified into four groups according to quartiles. The outcomes included stroke recurrence, poor functional outcome and all-cause mortality. ResultsIn a total of 1244 patients, the average age was 62.3years; 63.1% patients were male. At 1 year, the first quartile of HOMA- (<54.0) was associated with increased stroke recurrence (adjusted hazard ratio 2.04, 95% confidence interval 1.32-3.17, P=0.001), poor functional outcome (adjusted odds ratio 3.04, 95% confidence interval 1.90-4.88, P<0.001) and mortality (adjusted hazard ratio 4.12, 95% confidence interval 2.24-7.59, P<0.001) compared with the fourth quartile of HOMA- (166.3) after adjustment for insulin resistance and other potential covariates. The second and third quartiles of HOMA- were significantly associated with an increased risk of poor functional outcome. Multivariable regression analysis with restricted cubic splines showed an L-shaped association between HOMA- and outcomes at 1year. ConclusionsOur study shows that lower HOMA- level is associated with poor outcomes at 1year in non-diabetic patients with ischaemic stroke.