Risk of hand syndromes in patients with diabetes mellitus: A population-based cohort study in Taiwan

The aim of this study was to assess the overall and causespecific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications. The DM and control cohorts comprised 606,152 patients with DM and 609,970 age-and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders. Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI]=1.48-1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI=2.15- 3.24 and 2.99, 95% CI=2.55-3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR=1.90, 95% CI=1.86-1.95) and DD (HR=1.83, 95% CI=1.39- 2.39) than with CTS (HR=1.31, 95% CI=1.28-1.34) and LJM (HR=1.24, 95% CI=1.13-1.35). Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.