Objective: We examined whether older adults and adults stroke with diabetes had differences in clinical presentation of stroke severity and functional status. Methods: We performed a secondary data analysis from a stroke registry of a tertiary care and teaching hospital in the South of Thailand. We included acute ischemic stroke patients with diabetes who were admitted during October 2011 to February 2016. There were 396 older adults (52.7%) and 356(47.3%). There were a half of women (50.4%) and men (49.6%). The National Institute of Health Stroke Scale (NIHSS) and the Glasgow Coma Score (GCS) were used to assess stroke severity. Functional status was measured by using the Modified Rankin Scale (mRS) and the Barthel Index (BI). Independent t-test was performed to compare clinical severity and functional status on admission among women and men Results: Mean aged of the older adults and adult groups was 74.37 ± 6.64 and 54.51 ± 7.71, respectively. Older adults stroke with diabetes were more likely had clinical severity as determined by NISS (8.20 ± 6.83 vs 5.79 ± 4.66, t = 5.55, p = 0.000), and GCS (13.67 ± 2.51 vs 14.48 ± 1.50, t = 5.29, p = 0.000). Older adults were more likely presented functional limitation as determined by Barthel Index (64.35 ± 25.06 vs 74.15 ± 21.84, t = 5.69, p = 0.000). Older adults were more likely had higher mRS, but not reach to statistical differences (2.74 ± 1.57 vs 2.39 ± 5.14, t = 1.22, p = 0.222). Conclusion: Older adults stroke with diabetes had more clinical severity and had more functional limitation. As an advanced aged, they may need specific treatment protocol and rehabilitation regimens to improve their functional outcomes.