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Research Article
Volume 6 Issue 6 - 2021
Pulse Wave Analysis of HbA1c Categorized Prediabetes, Type 2 Diabetes and Normo-Glycemic Populations: A Pilot Study
Jennifer J Brown1,2* and Sheri R Colberg1
1Old Dominion University, Norfolk, Virginia, United States
2Elizabeth City State University, Elizabeth City, North Carolina, United States
*Corresponding Author: Jennifer J Brown, Elizabeth City State University, Elizabeth City, North Carolina, United States.
Received: May 14, 2021; Published: June 02, 2021


Introduction: Arterial stiffness is a significant risk factor for cardiovascular events and early detection is key for intervention and monitoring. This pathophysiological process is accelerated in type 2 diabetes (T2D), yet the onset of this condition has a limited body of research.

Purpose: To evaluate (1) arterial stiffness properties via pulse wave analysis (PWA) across a 4-group spectrum, and (2) determine whether waist-to-height-ratio (WHtR), waist circumference (WC) or body mass index (BMI) serves as the best predictor of early changes in PWA pathophysiology.

Methods: PWA was measured in 52 participants across four groups separated by HbA1c values: 14 normo-glycemic (N, 4.0 % -5.1 %), 15 high normal (HN, 5.2%-5.6 %), 10 prediabetes (PD, 5.7% -6.4 %) and 13 with T2D (T2D, ≥ 6.5%). Brachial, central and peripheral pressures, central and peripheral augmentation index (AIx) data were collected via Sphygmocor using validated methods after overnight caffeine abstinence and a minimum 4-hr fast. Group differences were evaluated via MANCOVAs. HbA1c, WHtR, WC and BMI data were assessed through regression to determine the best predictor.

Results: Significant differences were found between N to T2D and HN to T2D for brachial systolic blood pressure (SBP) [F(3,46) = 2.743, p < .05], brachial diastolic blood pressure (DBP) [F(3,46) = 3.329, p < .028] and brachial mean pressures (MP) [F(3,46) = 4.321, p < .009]. Central DBP and MP differed between N to T2D, and HN to PD and T2D groups [DBP:F(3,44) = 3.874, p < .015; MP:F(3,44) = 3.303, p < .029]. Central pulse pressure (PP) and CAIx showed no differences between groups. Peripheral pressures significantly differed between N and both PD and T2D; HN and both PD and T2D groups for peripheral SBP [F(3,44) = 3.007, p < .040], peripheral DBP [F(3,44) = 4.316, p < .009] and peripheral MP [F(3,44) = 3.487, p < .023], but not PP or PAIx. WHtR and WC were identified as the best predictors of CAIx after adjusting for age and height [R2 = .800, F(5,45) = 16.023, p < .0005; adj. R2 = .640], while PAIx had no significant predictor.

Conclusion: PWA may be effective for identifying differences in multiple brachial, central and peripheral pressure measures across a novel, pre-defined HbA1c spectrum; however, more research needs to be executed to validate these findings. WHtR and WC, but not BMI, effectively predicts CAIx

Keywords: Pulse Wave; Early Detection; Arterial Stiffness; Cardiovascular; Prediabetes


  1. Affuso F., et al. “Prehypertension and Elevated Risk of Cardiovascular Disease: Physiopathologic Mechanisms”. The American Journal of Medicine 120 (2007): e11.
  2. Milan A., et al. “Arterial Stiffness: From Physiology to Clinical Implications”. High Blood Pressure and Cardiovascular Prevention 18 (2011): 1-12.
  3. Tomiyama H., et al. “Effects of aging and persistent prehypertension on arterial stiffening”. Atherosclerosis 217 (2011): 130-134.
  4. Zheng X., et al. “Arterial Stiffness as a Predictor of Clinical Hypertension”. Journal of Clinical Hypertension 17 (2015): 582-591.
  5. Gajdova J., et al. “Pulse wave analysis and diabetes mellitus. A systematic review”. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc (2017): 161.
  6. Wittrock M., et al. “Regular Article: Noninvasive pulse wave analysis for the determination of central artery stiffness”. Microvascular Research 77 (2009): 109-112.
  7. Stoner L., et al. “Reliability of oscillometric central hemodynamic responses to an orthostatic challenge”. Atherosclerosis 241 (2015): 761-765.
  8. Bouchi R., et al. “Arterial Stiffness Is Associated With Incident Albuminuria and Decreased Glomerular Filtration Rate in Type 2 Diabetic Patients”. Diabetes Care 34 (2011): 2570-2575.
  9. Shen L., et al. “Increased Arterial Stiffness in Subjects with Pre-diabetes among Middle Aged Population in Beijing, China”. Biomedical and Environmental Sciences 26 (2013): 717-725.
  10. Campia U., et al. “Review article: The vascular endothelin system in obesity and type 2 diabetes: Pathophysiology and therapeutic implications”. Life Sciences 118 (2014): 149-155.
  11. Prenner SB and Chirinos JA. “Arterial stiffness in diabetes mellitus”. Atherosclerosis 238 (2015): 370-379.
  12. Metsämarttila E., et al. “Effect of physical activity on pulse wave velocity in elderly subjects with normal glucose, prediabetes or Type 2 Diabetes”. Scientific Reports 8 (2018): 1-10.
  13. Colak A., et al. “Postload hyperglycemia is associated with increased subclinical inflammation in patients with prediabetes”. Scandinavian Journal of Clinical and Laboratory Investigation 73 (2013): 422-427.
  14. Imrie H., et al. “Insulin resistance, lipotoxicity and endothelial dysfunction”. Biochimica et Biophysica Acta 1801 (2010): 320-326.
  15. Su Y. “The relationship between endothelial dysfunction and oxidative stress in diabetes and prediabetes”. International Journal of Clinical Practice 62 (2008): 877-882.
  16. Blacher J., et al. “Aortic stiffness, inflammation, denutrition and type 2 diabetes in the elderly”. Diabetes and Metabolism 38 (2012): 68-75.
  17. Catalano M., et al. “Arterial Stiffness: A Review in Type 2 Diabetes (2013).
  18. Bays HE. “Adiposopathy, diabetes mellitus, and primary prevention of atherosclerotic coronary artery disease: treating "sick fat" through improving fat function with antidiabetes therapies”. The American Journal of Cardiology 110 (2012): 4B-12B.
  19. Liu J-J., et al. “Obesity is a determinant of arterial stiffness independent of traditional risk factors in Asians with young-onset type 2 diabetes”. Atherosclerosis 236 (2014): 286-291.
  20. Kotecha D., et al. “Radial artery pulse wave analysis for non-invasive assessment of coronary artery disease”. International Journal of Cardiology 167 (2013): 917-924.
  21. Townsend RR., et al. “Clinical Use of Pulse Wave Analysis: Proceedings From a Symposium Sponsored by North American Artery”. Journal of Clinical Hypertension 17 (2015): 503-513.
  22. Vella S and Petrie JR. “Macrovascular disease: pathogenesis and risk assessment”. Medicine 43 (2015): 1-6.
  23. Najjar SS., et al. “Pulse wave velocity is an independent predictor of the longitudinal increase in systolic blood pressure and of incident hypertension in the Baltimore Longitudinal Study of Aging”. Journal of the American College of Cardiology 51 (2008): 1377-1383.
  24. Lyons TJ and Basu A. “Biomarkers in diabetes: hemoglobin A1c, vascular and tissue markers”. Translational Research 159 (2012): 303-312.
  25. Center for Disease Control and Prevention: CDC 24/7 Saving Lives PP. Diabetes Basics: Prediabetes - Your Chance to Prevent Type 2 Diabetes (2020).
  26. Ashwell M., et al. “Waist-to-Height Ratio Is More Predictive of Years of Life Lost than Body Mass Index”. PLoS ONE 9 (2014): e103483.
  27. Bluher S., et al. “Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development”. The Journal of Clinical Endocrinology and Metabolism 98 (2013): 3384-3393.
  28. Arnold TJ., et al. “Neck and waist circumference biomarkers of cardiovascular risk in a cohort of predominantly African-American college students: a preliminary study”. Journal of the Academy of Nutrition and Dietetics 114 (2014): 107-116.
  29. Ashwell M., et al. “Waist-to-height ratio is a better screening tool than waist circumference and BMI for adult cardiometabolic risk factors: systematic review and meta-analysis”. Obesity Reviews 13 (2012): 275-286.
  30. Cristo Rodríguez Pérez MD., et al. “[The waist to height ratio as an index of cardiovascular risk and diabetes]”. Medicina Clínica 134 (2010): 386-391.
  31. Tamborlane WV., et al. “Comparison of fingerstick hemoglobin A1c levels assayed by DCA 2000 with the DCCT/EDIC central laboratory assay: results of a Diabetes Research in Children Network (DirecNet) Study”. Pediatric Diabetes 6 (2005): 13-16.
  32. Agnoletti D., et al. “Pulse pressure amplification, pressure waveform calibration and clinical applications”. Atherosclerosis 224 (2012): 108-112.
  33. Liu IT., et al. “Mild Chronic Kidney Disease Associated with Greater Risk of Arterial Stiffness in Elderly Adults”. Journal of the American Geriatrics Society 61 (2013): 1758-1762.
  34. Ding F-H., et al. “Validation of the noninvasive assessment of central blood pressure by the SphygmoCor and Omron devices against the invasive catheter measurement”. American Journal of Hypertension 24 (2011): 1306-1311.
  35. Avolio AP., et al. “Role of Pulse Pressure Amplification in Arterial Hypertension: Experts’ Opinion and Review of the Data”. Hypertension 54 (2009): 375-383.
  36. Avolio AP., et al. “Arterial blood pressure measurement and pulse wave analysis--their role in enhancing cardiovascular assessment”. Physiological Measurement 31 (2010): R1-47.
  37. Chowienczyk P. “Pulse Wave Analysis: What Do the Numbers Mean?” Hypertension 57 (2011): 1051-1052.
  38. O'Rourke MF and Seward JB. “REVIEW: Central Arterial Pressure and Arterial Pressure Pulse: New Views Entering the Second Century After Korotkov”. Mayo Clinic Proceedings 81 (2006): 1057-1068.
  39. O'Rourke MF and Pauca AL. “Augmentation of the aortic and central arterial pressure waveform”. Blood Pressure Monitoring 9 (2004): 179-185.
  40. Johnson AR., et al. “The inflammation highway: metabolism accelerates inflammatory traffic in obesity”. Immunological Reviews 249 (2012): 218-238.
  41. Adamczak M and Wiecek A. “The adipose tissue as an endocrine organ”. Seminars in Nephrology 33 (2013): 2-13.
  42. Cheon DY., et al. “Serum chemerin levels are associated with visceral adiposity, independent of waist circumference, in newly diagnosed type 2 diabetic subjects”. Yonsei Medical Journal 58 (2017): 319-325.
  43. Aatola H., et al. “Prospective Relationship of Change in Ideal Cardiovascular Health Status and Arterial Stiffness: The Cardiovascular Risk in Young Finns Study”. Journal of the American Heart Association (2014): 3.
  44. Tigbe WW., et al. “Time spent in sedentary posture is associated with waist circumference and cardiovascular risk”. International Journal of Obesity 41 (2017): 689.
  45. Alberto PA., et al. “Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment”. Physiological Measurement 31 (2010): R1.
  46. Chen Q., et al. “Arterial stiffness is elevated in normotensive type 2 diabetic patients with peripheral neuropathy”. Nutrition, Metabolism and Cardiovascular Diseases (2015).
  47. Weisbrod RM., et al. “Arterial Stiffening Precedes Systolic Hypertension in Diet-Induced Obesity”. Hypertension 62 (2013): 1105-1110.
  48. Bian S., et al. “Arterial stiffness and central hemodynamics in apparently healthy adults with impaired glucose regulation or high-normal blood pressure (2012).
  49. Koivistoinen T., et al. “Pulse wave velocity predicts the progression of blood pressure and development of hypertension in young adults”. Hypertension 71 (2018): 451-456.
  50. Schneider HJ., et al. “Measuring abdominal obesity: effects of height on distribution of cardiometabolic risk factors risk using waist circumference and waist-to-height ratio”. Diabetes Care 34 (2011): e7.
  51. Schneider HJ., et al. “The predictive value of different measures of obesity for incident cardiovascular events and mortality”. The Journal of Clinical Endocrinology and Metabolism 95 (2010): 1777-1785.
Citation: Jennifer J Brown and Sheri R Colberg. “Pulse Wave Analysis of HbA1c Categorized Prediabetes, Type 2 Diabetes and Normo-Glycemic Populations: A Pilot Study”. EC Endocrinology and Metabolic Research 6.6 (2021): 01-12.

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