Cross-sectional assessment of cerebral hemodynamics in individuals with type 2 diabetes and orthostatic hypotension

This cross-sectional study investigated the cerebral hemodynamics of patients with type 2 diabetes (T2DM) with varying orthostatic hypotension (OH) statuses. Using transcranial Doppler (TCD), we assessed cerebral blood flow velocities (CBFv) and pulsatility index (PI) during a supine-to-stand test (STST) in 159 patients with T2DM. Statistical tests compared mean CBFv and PI between T2DM patients with and without OH, and logistic regression analyses assessed the association between OH and CBFv response to upright. We also analyzed orthostatic intolerance (OI) symptoms. T2DM + OH patients experienced a significant drop in mean CBFv during active standing compared to T2DM-OH patients (12.91 ± 10.64 cm/s vs 9.79 ± 7.60, P = 0.026). Patients were stratified by OI status, revealing that T2DM + OH + OI patients had a faster drop in systolic, mean, and diastolic CBFv during standing compared to other groups. Additionally, T2DM + OH + OI patients exhibited significantly higher PI levels at 1- and 3-min of active standing compared to other groups. T2DM patients with OH experienced an increased odds of blunted CBFv rebound and abnormal CBFv response to upright compared to those without OH. These findings suggest that altered cerebral hemodynamics may contribute to OI in these patients. Further large-scale cohort studies are needed to confirm these findings.