Presence of Diabetes Linked to Carpal Tunnel Syndrome Occurrence

Credit: Tiana/Pexels

A new systematic review and meta-analysis demonstrated a statistically significant risk of carpal tunnel syndrome (CTS) among patients with both type 1 (T1D) and type 2 diabetes (T2D), compared with non-diabetic individuals.¹

These diabetic patients demonstrated a 90% greater risk of developing the condition, with sex representing a modifying variable— studies with a higher proportion of men exhibited a lower likelihood of CTS occurrence than those with a higher proportion of women.

“The results of this study can be highly beneficial for health professionals in making well-informed decisions and adopting evidence-based preventive measures for patients with diabetes,” wrote the investigative team, led by Abdollah Mohammadian-Hafshejani, assistant professor of epidemiology, Shahrekord University of Medical Sciences.

The leading cause of sick leave and work disability among working-age adults, CTS demonstrates a serious impact on the global adult population.² Various health conditions have been linked with the syndrome, including metabolic disorders and obesity, with diabetes having been highlighted as a potential risk factor.

Multiple recent studies have assessed the relationship between diabetes and CTS, with numerous reporting an increased risk of developing CTS in the presence of diabetes.³ On the other hand, some studies have demonstrated no association between diabetes and the occurrence of CTS.⁴

Given the inconsistencies in risk between diabetes and CTS, Mohammadian-Hafshejani and colleagues conducted a systematic review and meta-analysis to investigate the association using all available literature.¹ A comprehensive search was conducted in the PubMed, ISI Web of Knowledge, Cochrane, Embase, Google Scholar, and Scopus databases, using diabetes as an exposure and CTS as an outcome, until the end of 2022.

The primary study objective was to assess this association and to determine the relationship’s effect size, with a 95% confidence interval (CI) presented in the articles matching inclusion criteria or calculated based on the provided information.

A total of 2060 articles were initially identified in the electronic database search and 1448 were excluded due to being unrelated to the research topic. These exclusions resulted in 49 potentially relevant papers and further exclusions left a total of 42 observational articles for the study. These articles combined for a study population of 3,377,816 participants between 1991 and 2022.

Overall, results from the meta-analysis revealed the odds ratio (OR) of CTS among individuals with a history of diabetes, compared with those who did not, was 1.90 (95% CI, 1.64 - 2.21; P <.001). These data suggest the presence of diabetes statistically significantly increased the odds of CTS by 90%.

A meta-regression was performed to investigate the cause of heterogeneity in study results, with variables including year, study design, sample size, quality of study, and sex ratio (male to female) of participants. According to these data, the sex ratio was the only variable significantly contributing to the heterogeneity in the results of the analyzed studies.

Mohammadian-Hafshejani and colleagues noted the limitations of observational studies stem from the presence of confounding variables when examining the connection between exposure and outcome, despite attempts to control for them. As a result, they urged caution in interpreting these results, without enough evidence to establish a causal link between diabetes and CTS.

“Consequently, it is not possible to infer causal inference relationships between exposure and outcome in these studies, and should only interpret the relationship between variables,” investigators wrote.

References

1. _{Sanjari E, Raeisi Shahraki H, G Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach. PLoS One. 2024;19(4):e0299442. Published 2024 Apr 16. doi:10.1371/journal.pone.0299442}
2. _{Mitake T, Iwatsuki K, Hirata H. Differences in characteristics of carpal tunnel syndrome between male and female patients. J Orthop Sci. 2020;25(5):843-846. doi:10.1016/j.jos.2019.10.01}
3. _{Rydberg M, Zimmerman M, Gottsäter A, Svensson AM, Eeg-Olofsson K, Dahlin LB. Diabetic hand: prevalence and incidence of diabetic hand problems using data from 1.1 million inhabitants in southern Sweden. BMJ Open Diabetes Res Care. 2022;10(1):e002614. doi:10.1136/bmjdrc-2021-002614}
4. _{Evanoff B, Zeringue A, Franzblau A, Dale AM. Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome. Hum Factors. 2014;56(1):166-177. doi:10.1177/0018720813496567}