Hemodynamic phenotypes defined by arterial stiffness index and pulse pressure were associated with differential risks of diabetic microvascular complications in type 2 diabetes, with elevated pulse pressure—rather than elevated arterial stiffness index—consistently associated with increased microvascular risk.
Three distinct hemodynamic phenotypes were identified from UK Biobank participants with type 2 diabetes using k-means clustering based on ASI and PP.
The high PP phenotype was associated with a significantly higher risk of diabetic microvascular complications compared to the low ASI-low PP phenotype.
ASI and PP showed distinct nonlinear associations with diabetic microvascular complications.
ASI and PP showed differential associations with specific microvascular complication subtypes.
Elevated pulse pressure, rather than elevated arterial stiffness index, was consistently associated with increased microvascular risk in type 2 diabetes.
This research used data from over 9,000 people with type 2 diabetes in the UK Biobank to examine how two measures of blood vessel health—arterial stiffness index (ASI, a measure of how rigid arteries are) and pulse pressure (PP, the difference between systolic and diastolic blood pressure)—relate to the development of small blood vessel complications like kidney disease, eye disease, and nerve damage. Researchers grouped participants into three profiles based on these measures: a low-stiffness/low-pulse-pressure group, a high-pulse-pressure group, and a high-stiffness group. Over nearly 13 years of follow-up, about 2,350 participants developed microvascular complications. The study found that people in the high-pulse-pressure group had about a 16% higher risk of developing microvascular complications compared to those in the low-stiffness/low-pulse-pressure group, and this finding was consistent across different statistical methods. Interestingly, the high-stiffness group did not show a significantly elevated overall risk. When looking at specific complications, arterial stiffness was mainly linked to kidney disease, while pulse pressure was linked to both kidney disease and eye disease. The two hemodynamic measures also showed different shaped (nonlinear) relationships with complication risk. This research suggests that pulse pressure and arterial stiffness, while related, may affect small blood vessels through different biological pathways in people with type 2 diabetes. The findings indicate that tracking pulse pressure specifically may be important for identifying diabetes patients at higher risk for microvascular complications, and that these two hemodynamic measures should not be treated as interchangeable indicators of cardiovascular risk in this population.
Sun A, Liu H, Yang X, Guo H, Zeng R, Deng Y, et al.. (2026). Hemodynamic phenotypes defined by arterial stiffness index and pulse pressure with risk of diabetic microvascular complications in type 2 diabetes.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1917833