Objective To explore the influencing factors of stroke-associated pneumonia(SAP)in patients with acute ischemic stroke(AIS)complicated with type 2 diabetes mellitus(T2DM)and to establish a related predictive model.Methods A total of 125 patients with AIS complicated with T2DM from September 2021 to September 2023 were divided into SAP group(n=28)and non-SAP group(n=97)according to the diagnostic criteria of SAP.The clinical data of two groups of patients were collected,the etiology of SAP group was analyzed,and the influencing factors of SAP were discussed.The related predictive model was established,and the ROC curve was used to test the application value of the model.Results The main pathogens in SAP group were gram-negative bacilli(73.9％).There were significant differences in disturbance of consciousness,indwelling gastric tube,acid inhibitor,glycosylated hemoglobin,fasting blood glucose,albumin,D-dimer,neutrophil/lymphocyte ratio(NLR),platelet/lymphocyte ratio between SAP group and non-SAP group(all P＜0.05).Logistic analysis showed that disturbance of consciousness,indwelling gastric tube,use of acid suppressants,glycosylated hemoglobin and NLR were independent risk factors for SAP(all P＜0.05).ROC analysis showed that the predictive model predicted the area under the SAP curve was 0.948(95％CI:0.911-0.986).The best cutoff value was 0.217,the sensitivity was 0.893 and the specificity was 0.866.Conclusions Gram-negative bacilli are the main pathogens of SAP in AIS patients with T2DM.Disturbance of consciousness,indwelling gastric tube,use of acid suppressants,glycosylated hemoglobin and NLR are independent risk factors for SAP.The model based on these factors has high predictive value.