Key result
High pulse pressure phenotype is linked to ~16% higher risk of diabetic microvascular complications.
Why the study?
The associations of hemodynamic phenotypes defined by arterial stiffness index and pulse pressure with incident diabetic microvascular complications in type 2 diabetes were unclear.
Does a high pulse pressure phenotype increase the risk of incident diabetic microvascular complications in individuals with type 2 diabetes?
Cohort (n=9,163)
Yes
Does a high pulse pressure phenotype increase the risk of incident diabetic microvascular complications in individuals with type 2 diabetes?
Hazard Ratio: 1.16 (95% CI 1.05–1.28)
Absolute Event Rate: 30.9% vs 23%
p-value: p=<0.05
In individuals with type 2 diabetes, elevated pulse pressure is a more consistent predictor of incident microvascular complications than arterial stiffness index.
Does not support practice change in type 2 diabetes; leaves open predictive value of pulse pressure phenotypes pending prospective validation.
Objective: To identify hemodynamic phenotypes based on arterial stiffness index (ASI) and pulse pressure (PP) and examine their associations with incident diabetic microvascular complications (DMC) in individuals with type 2 diabetes (T2D). Methods: A total of 9,163 participants with T2D free of DMC at baseline were included from the UK Biobank. K-means clustering based on ASI and PP was used to identify hemodynamic phenotypes. Associations with incident DMC were evaluated using cause-specific Cox and Fine-Gray models. Restricted cubic spline analyses assessed nonlinear associations. Secondary analyses examined diabetic kidney disease (DKD), diabetic retinopathy (DR), and diabetic neuropathy (DN). Results: During a median follow-up of 12.9 years, 2,349 participants developed DMC. Three phenotypes were identified. Compared with the low ASI-low PP phenotype, the high PP phenotype was associated with a higher risk of DMC in both cause-specific Cox models (hazard ratio [HR] 1.16, 95% CI 1.05-1.28) and Fine-Gray models (subdistribution hazard ratio [SHR] 1.16, 95% CI 1.05-1.29), whereas no significant association was observed for the high ASI phenotype. ASI and PP showed L-shaped and J-shaped associations with DMC, respectively. ASI was primarily associated with DKD, whereas PP was associated with both DKD and DR. Conclusions: Hemodynamic phenotypes defined by ASI and PP were associated with differential risks of DMC in T2D. Elevated PP, rather than elevated ASI, was consistently associated with increased microvascular risk. Distinct associations of ASI and PP suggest heterogeneous hemodynamic pathways underlying DMC.
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Sun et al. (2026) conducted a cohort in Type 2 diabetes (n=9,163). High pulse pressure (PP) phenotype vs. Low arterial stiffness index (ASI) and low PP phenotype was evaluated on Incident diabetic microvascular complications (composite of diabetic kidney disease, diabetic neuropathy, or diabetic retinopathy) (HR 1.16, 95% CI 1.05-1.28, p=<0.05). The high pulse pressure phenotype was associated with a 16% higher risk of incident diabetic microvascular complications compared to the low arterial stiffness index and low pulse pressure phenotype (HR 1.16).
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