Specialists are calling for shoulder and hand disorders to be brought into routine diabetes care after evidence showed they are common, painful and largely absent from major guidelines.
Upper-limb complications in diabetes have long sat in the shadows of better-known problems such as eye, kidney and foot disease, but specialists now argue they deserve a far more prominent place in routine care. At the European Association for the Study of Diabetes annual meeting, clinicians devoted a full session to the issue, reflecting growing concern that shoulder and hand disorders linked to diabetes are being missed in everyday practice.
The group of conditions includes adhesive capsulitis, also known as frozen shoulder, Dupuytren contracture, trigger finger, carpal tunnel syndrome, ulnar nerve compression, rhizarthrosis at the base of the thumb and limited joint mobility in the hand. According to the Medscape report translated from its French edition, these problems are largely absent from major adult diabetes guidelines, including those of the American Diabetes Association, the European Association for the Study of Diabetes and the National Institute for Health and Care Excellence. An exception is the 2022 International Society for Pediatric and Adolescent Diabetes guidance, which recommends regular clinical examination for limited joint mobility and related complications in children and adolescents with type 1 diabetes.
Kirsten Nørgaard of Steno Diabetes Center Copenhagen said the burden is “completely underestimated” in people with type 1 diabetes. She told the conference that the conditions can increase absenteeism, prompt the need for workplace adjustments, worsen psychological well-being and deepen diabetes-related distress, while the impact grows as more joints are affected. Nørgaard also pointed to research that is due to be published, suggesting that people with long-standing type 1 diabetes and either hand or shoulder problems report substantial pain, even compared with those who have vascular complications and prolonged poor glucose control.
Evidence from earlier reviews supports that concern. A 2025 review in Diabetes Care found upper-limb complications are roughly two to three times more common in people with diabetes than in the general population, with risk rising after the age of 50 and in those with long-standing disease. Barbara H. Braffett of George Washington University, who analysed data from the DCCT and EDIC studies, described the upper limb as a “blind spot” in diabetes care. After an average of 31 years living with diabetes, she said, 66% of participants had at least one such complication, most commonly frozen shoulder, carpal tunnel syndrome and trigger finger.
Tore Julsrud Berg of Oslo University Hospital said screening should be considered for people over 30 who have had diabetes for more than a decade, particularly if they have chronic high blood sugar or microvascular complications, although symptoms can also appear earlier. He said diagnosis is clinical and should be guided by symptoms such as painful shoulder stiffness, numbness, tingling, reduced grip strength or finger stiffness. The practical message from the meeting was clear: these are not rare or trivial problems, and in many patients they are likely to be both under-recognised and undertreated.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
