Objective Wave intensity (WI) is a novel hemodynamic index that provides quantitative information about the dynamic interactions between the heart and vascular system. We sought to evaluate the working condition of the heart interacting with the arterial system in diabetic patients (DM) with WI. Methods We studied 66 diabetic patients with normal left ventricular ejection fraction and 66 healthy control subjects. The diabetic patients were divided into DM with microangiopathy subgroup (n = 36) and DM without microangiopathy subgroup (n = 30). Real time WI was recorded using ALOKA α-10 machine, and the magnitudes of the first peak (W1) and the second peak (W2) as well as the negative area (NA) of carotid artery were measured. Results The values of W1 and NA in DM with microangiopathy subgroup were much lower than those in the age-matched controls (W1: P<0.001, NA: P = 0.015), and no significant difference was found in W2. The values of W1 and NA in DM without microangiopathy subgroup did not significantly differ from the age-matched control subgroup. Conversely, the value of W2 of this subgroup was much lower than the controls (P = 0.039). Conclusion Carotid arterial WI parameters play an important role in evaluating the impaired working condition of both heart and arterial system of diabetic patients.