Two-thirds of people with long-term diabetes develop overlooked upper-limb problems

Specialists are urging clinicians to look beyond glucose control after long-term data showed that upper-limb disorders are common, disabling and rarely included in routine diabetes screening.

Upper-limb complications in diabetes have long sat in the background of routine care, despite evidence that they are common, disabling and often missed. At the European Association for the Study of Diabetes annual meeting, specialists highlighted a group of disorders that includes frozen shoulder, Dupuytren contracture, trigger finger, carpal tunnel syndrome, ulnar nerve compression, thumb-base osteoarthritis and limited joint mobility of the hand. Medscape reported that the discussion reflected a growing concern that these problems are still under-recognised in everyday diabetes management, even though they can affect work, sleep, mood and daily function.

That gap matters because, according to a 2025 review in Diabetes Care, these upper-limb problems occur about two to three times more often in people with diabetes than in the general population, with risk rising after the age of 50 and with longer disease duration. Barbara H. Braffett of George Washington University, who analysed DCCT/EDIC data, said the upper extremity is a blind spot in diabetes care. After an average of 31 years with diabetes in that cohort, 66% of participants had at least one upper-limb complication, including frozen shoulder, carpal tunnel syndrome, trigger finger, limited joint mobility and Dupuytren contracture.

The problem is especially relevant in type 1 diabetes, where Kirsten Nørgaard of Steno Diabetes Center Copenhagen said upper-limb complications are a “completely underestimated burden”. She told the EASD session that they can increase absenteeism, require workplace adjustments, worsen psychological well-being and intensify diabetes-related distress, with the burden rising as more joints are affected. Nørgaard also pointed to research being prepared for publication suggesting that people with long-standing type 1 diabetes who develop hand or shoulder problems report substantial pain, sometimes more than those with vascular complications and prolonged poor glucose control.

Screening remains inconsistent because major general diabetes guidelines from the American Diabetes Association, the European Association for the Study of Diabetes and the National Institute for Health and Care Excellence do not routinely address these disorders. The main exception is the 2022 International Society for Pediatric and Adolescent Diabetes guidance, which recommends regular clinical examination for limited joint mobility and related problems in children and adolescents with type 1 diabetes. Tore Julsrud Berg of Oslo University Hospital said clinicians should consider screening adults over 30 who have lived with diabetes for more than a decade, especially if they have chronic hyperglycaemia or microvascular complications, while noting that symptoms may appear earlier. He outlined the key warning signs of each condition, from painful shoulder stiffness and hand numbness to triggering fingers, reduced grip strength and the classic “prayer sign” seen in limited joint mobility. Mayo Clinic and the University of California, San Francisco both note that early recognition can help patients manage symptoms and preserve function.