OBJECTIVE: To determine the influence of central obesity and type 2 diabetes on peripheral wave reflection in Indigenous Australians. DESIGN AND METHODS: A cross-sectional study of remote Indigenous Australians with (n = 43) and without (n = 54) type 2 diabetes of similar age (47 years) and sex; using anthropometric and bioelectrical impedance measures of obesity and applanation tonometry to determine the aortic augmentation index (AI) as an index of peripheral wave reflection. RESULTS: Indices of obesity were significantly higher in the diabetic than non-diabetic participants [body mass index (BMI): 27.3 versus 24.6 kg/m, P = 0.018; waist circumference: women 101 versus 94 cm, P = 0.008, men 102 versus 91 cm, P = 0.039]. AI was negatively related to obesity: BMI (r = -0.35, P = 0.0003), weight (r = -0.44, P < 0.0005), waist circumference (r = -0.34, P = 0.0003) and fat mass (r = -0.35, P < 0.0005). There was no significant difference in AI between the groups with and without diabetes. On multiple regression analysis, 66% of the variance in AI was explained with the following significant predictors: age, heart rate, male gender, fat mass and mean arterial pressure. Similar results were obtained when weight, waist circumference or BMI were substituted for fat mass. CONCLUSION: When compared with Indigenous Australians without diabetes, those with type 2 diabetes do not have greater aortic pressure augmentation from peripheral wave reflection. However, obesity, irrespective of the index used, was related to lower peripheral wave reflection in both those with and without type 2 diabetes.