Elevated risk of fibrotic hand manifestations in diabetes: a systematic review and meta-analysis of case-control studies
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Background
Diabetes mellitus is associated with a cluster of hand manifestations—including Dupuytren’s disease (DD), flexor tenosynovitis (FT), limited joint mobility (LJM), and carpal tunnel syndrome (CTS)—collectively termed the “diabetic hand.” While these conditions share a common profibrotic histopathology, the magnitude and consistency of risk across populations remain unclear.
Methods
We reviewed and meta-analyzed case-control studies quantifying the risk of individual and combined fibrotic hand manifestations in individuals with diabetes compared to non-diabetic controls. We searched five databases (last updated August 2024) for case-control studies reporting prevalence of DD, FT, LJM, or CTS in individuals with diabetes. Pooled risk ratios (RRs) were calculated using a random-effects model. Subgroup analyses were conducted by diabetes type and publication year.
Results
Fifty-one case-control studies were included. In type 2 diabetes, pooled RRs were: DD 2.58 [1.85–3.60], FT 3.54 [2.07–6.05], LJM 3.18 [2.43–4.15], CTS 2.95 [1.83–4.77]. In type 1 diabetes, corresponding RRs were higher: DD 4.33 [1.69–11.12], FT 5.67 [2.25–14.30], LJM 3.98 [3.00–5.29], CTS 4.57 [2.46–8.49]. The combined risk of any hand fibrosis in type 2 diabetes was 3.39 [2.60–4.43]. Substantial heterogeneity was observed across studies.
Conclusion
Diabetes significantly increases the risk of all four fibrotic hand manifestations, with higher relative risks in type 1 diabetes. These findings probably support the concept of a shared fibrotic pathway and highlight the need for standardized diagnostic criteria and longitudinal assessment of musculoskeletal complications in diabetes.
Protocol
Registered prospectively with PROSPERO (CRD42022257285)
Funding
DBT/Wellcome India Alliance Fellowship (IA/CPHE/19/1/504607) to Dr Sanat Phatak
Research in context
What is already known about this subject?
Diabetes is associated with certain fibrotic hand conditions (Dupuytren’s disease (DD), flexor tenosynovitis (FT), limited joint mobility (LJM), and carpal tunnel syndrome (CTS)—collectively termed the diabetic hand). Hyperglycemia is known to be causal in developing these conditions but the relative risks and consistency across populations have not been systematically quantified.
What is the key question?
What is the pooled risk of developing individual and combined hand manifestations in people with diabetes compared to non-diabetic controls?
What are the new findings?
Diabetes increases the risk of Dupuytren’s disease, flexor tenosynovitis, limited joint mobility, and carpal tunnel syndrome. All four manifestations have similar relative risks.
Relative risks were higher in patients with type 1 diabetes as compared to type 2 diabetes.
Substantial heterogeneity in studies highlights the need for standardized definitions and quantification methods.
How might this impact on clinical practice in foreseeable future?
Better recognition and measurement of the ‘diabetic hand’ as a clinical entity may prompt earlier diagnosis, functional assessment, and could serve as a screening tool for identifying a broader profibrotic tendency in diabetes.
