Elevated risk of fibrotic hand manifestations in diabetes: a systematic review and meta-analysis of case-control studies

BackgroundDiabetes mellitus is associated with a cluster of hand manifestations--including Dupuytrens 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. MethodsWe 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. ResultsFifty-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. ConclusionDiabetes 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. ProtocolRegistered prospectively with PROSPERO (CRD42022257285) FundingDBT/Wellcome India Alliance Fellowship (IA/CPHE/19/1/504607) to Dr Sanat Phatak Research in contextO_LIWhat is already known about this subject? Diabetes is associated with certain fibrotic hand conditions (Dupuytrens 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. C_LIO_LIWhat 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? C_LIO_LIWhat are the new findings? O_LIDiabetes increases the risk of Dupuytrens disease, flexor tenosynovitis, limited joint mobility, and carpal tunnel syndrome. All four manifestations have similar relative risks. C_LIO_LIRelative risks were higher in patients with type 1 diabetes as compared to type 2 diabetes. C_LIO_LISubstantial heterogeneity in studies highlights the need for standardized definitions and quantification methods. C_LI C_LIO_LIHow 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. C_LI