背景:糖尿病是國內外常見的代謝異常疾病，且目前糖尿病之盛行率與發生率在國內外都有逐漸上升的趨勢；糖尿病患者長期處於高血糖狀態下且隨著年齡增加與病程時間增長，易衍生出糖尿病相關合併症，除了視網膜病變、神經病變、腎病變之外，合併症影響範圍亦會涉及骨頭、關節與周邊軟組織，近而牽連到上肢肌肉骨骼的異常，而有所謂的「糖尿病手部症候群」，若不正視此問題，可能導致國家龐大的醫療經濟支出及病患的生活品質下降。目前國外已有不少有關糖尿病手部症候群之研究，而我國目前尚缺乏糖尿病手部症候群之描述性流行病學數據；同時，許多糖尿病患者並不知道自己本身罹患糖尿病，因此可能誤以為手部症候群的出現是其他原因所造成。
目的: 本研究分析我國糖尿病手部症候群之盛行率與發生率；此外，本研究也探討糖罹患手部症候群之個案在之後被發現發生糖尿病的風險是否較高?若有此現象，那可能隱含有部分未診斷的糖尿病患者出現手部症狀的就醫行為，本研究也藉此評估是否可以利用糖尿病手部症候群的發生做為臨床偵測未診斷糖尿病之症候依據。
材料與方法:本研究利用向國家衛生研究院申請之全民健康保險資料庫進行三部分的研究分析，第一部分利用門診資料庫建立2000年糖尿病世代（N=606,152）與經年齡與性別進行頻率匹配的對照組世代（N=609,970)，追蹤期間為2000年至2008年，分析腕隧道症候群、扳機指、關節活動受限與掌腱膜攣縮症之發生密度，與校正潛在干擾因子後的相對危險性估計值。第二部分利用2010年百萬人歸人資料，以橫斷性研究設計比較2010年糖尿病患（N=57,093）與1：1進行年齡、性別、與地區別匹配之對照組（N=57,093）進行手部症狀盛行率之分析。第三部分則是以巢式病例對照研究設計，探討因糖尿病手部症候群而求診之病人是否會增加日後罹患糖尿病的風險?此部分以2005年百萬人歸人檔為研究材料，建立於2005-2010年間新診斷之第2型糖尿病患（N=33,571），並以1：5進行時間密度取樣，選取對照組個案（N=167,777)，並將病例組與對照組個案回溯至1997年，擷取可能之糖尿病手部症狀就醫記錄，以條件式羅輯斯迴歸模式分析糖尿病發生個案過去曾出現糖尿病手部症狀診斷的勝算比，並同時計算從糖尿病手部症狀出現至糖尿病被診斷的時間間隔與手部症狀的就醫科別分佈情形；此外，也進一步計算利用手部症狀預測糖尿病發生的效度與成效。
結果:本研究發現糖尿病患容易患有糖尿病相關手部症狀，其盛行率與發生密度皆較對照組（非糖尿病族群）高，我國糖尿病世代與對照組世代之全病因手部症狀發生密度分別為117.7／10,000人年與80.7／10,000人年；原因別手部症狀之發生密度以腕隧道症候群（63.54／10,000人年）與扳機指（57.5／10,000人年）較高。校正後之全病因手部症狀相對風險為1.30 （95% Confidence Interval （CI）=1.28-1.33），性別與年齡分層間的相對風險中以<35歲為高，分別為男性的1.97（95% CI=1.55-2.52）與女性的2.46（95% CI=2.05-2.94）。此外，手部症狀盛行率多集中於女性、35-64歲、與北部地區。研究亦發現：約有7.8%新診斷之第二型糖尿病患者先前曾有糖尿病手部症狀之就醫記錄，校正潛在干擾因子後的勝算比顯著增加為1.23（95%CI=1.16-1.30），不過僅有少部分有手部症狀之個案在手部診斷三個月內被診斷出第二型糖尿病，大部分手部症狀患者是在約二年後被診斷出糖尿病。此外，利用手部症狀來預測第二型糖尿病之特異性與陰性預測值高，但敏感度與陽性預測值則較低。
結論:我國的糖尿病患者有顯著較高的糖尿病手部症候群發生率與盛行率，但相較之下，盛行率數據較國外數據略低。本研究也發現：手部症狀在年輕的男性糖尿病個案上有較高的相對風險，且以扳機指、掌腱膜攣縮症與糖尿病之間的相關性較高。本研究的數據也顯示：可能有部分未診斷之糖尿病患者是先發生手部症狀前去就醫，不過，利用手部症狀的發生作為臨床偵測第二型糖尿病工具的敏感度與陽性預測值不佳，但特異性與陰性預測值則較佳。

This study aimed to assess the prevalence and incidence rates of diabetic hand syndroms (DHS) in Taiwan, and to investigate if whether there is an increased risk of DM following DHS diagnosis. Data analyzed in this study were retrieved from the National Health Insurance Research Data in Taiwan. Over the study period of 2000-2008, the incidence density (ID) of all-cause DHS for diabetic and control cohort was estimated at 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was noted for carpal tunnel syndrome (63.5per 10,000 person-years), followed by flexor tenosynovitis (57.5per 10,000 person-years). After adjustment for potential confounders, patients with DM experienced a significantly elevated hazard ratio of all-cause DHS at 1.30 (95%CI, 1.28-1.33). In patients with diabetes, the prevalence of all-cause DHS was observed to be higher in women, those aged 35-64 years, and people from Northern Taiwan. We noted that some 7.8% of newly diagnosed Type 2 diabetes mellitus (T2DM) patients had a prior diagnosis of DHS. Only a small portion of patients with DHS developed T2DM in 3 months following the last ambulatory care visit for DHS. The positive predictive values for DHS in predicting T2DM was about 10%, and the negative predictive value was around 90%.

Al-Matubsi HY, Hamdan F, Alhanbali OA, Oriquat GA, Salim M. Diabetic hand syndromes as a clinical and diagnostic tool for diabetes mellitus patients. Diabetes Res Clin Pract2011;94(2):225-229.
Al-Qattan MM. Factors in the pathogenesis of Dupuytren's contracture. J Hand Surg Am2006; 31(9):1527-1534.
Ardic F, Soyupek F, KahramanY, Yorgancioglu R.The musculoskeletal complications seen in type II diabetics: predominance of hand involvement. Clin Rheumatol2003; 22(3): 229-233.
Arkkila PE, Kantola IM, Viikari JS, Ronnemaa T. Shoulder capsulitis in type I and II diabetic patients: association with diabetic complications and related diseases. Ann Rheum Dis1996;55(12): 907-914.
Arkkila PE, Kantola IM,Viikari JS. Dupuytren's disease: association with chronic diabetic complications. J Rheumatol1997;24(1):153-159.
Ballantyne J, Hooper G. The hand and diabetes. Current Orthopaedic, 2004;18(2):118-125.
Bayes M, Price M. An Essay towards Solving a Problem in the Doctrine of Chances. By the Late Rev. Mr. Bayes, F. R. S. Communicated by Mr. Price, in a Letter to John Canton, A. M. F. R. S. Philosophical Transaction, 1763;53: 370-418.
BeckerJ, Nora DB, Gomes I, Stringari FF, Seitensus R, Panosso JS, et al. An evaluation of gender, obesity, age and diabetes mellitus as risk factors for carpal tunnel syndrome. Clin Neurophysiol 2002;113(9):1429-1434.
Burt S, Deddens JA, Crombie K, Jin Y, Wurzelbacher S, Ramsey J. A prospective study of carpal tunnel syndrome: workplace and individual risk factors. Occup Environ Med 2013;70(8): 568-574.
Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med 2002;112(6): 487-490.
Campbell RR, Hawkins SJ, Maddison PJ, Reckless JP. Limited joint mobility in diabetes mellitus. Ann Rheum Dis 1985;44(2): 93-97.
Chammas M, Bousquet P, Renard E, Poirier JL, Jaffiol C, Allieu Y. Dupuytren's disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am 1995;20(1): 109-114.
Chen HF, Chen P, Li CY. Risk of malignant neoplasms of liver and biliary tract in diabetic patients with different age and sex stratifications. Hepatology 2010;52(1):155-163.
Chuang LM, Tsai ST, Huang BY, Tai TY. the DIABCARE (Taiwan) Study
Group:The current state of diabetes management in Taiwan. Diabetes Res Clin Pract 2001;54(1):55–65.
Crispin JC, Alcocer-Varela J. Rheumatologic manifestations of diabetes
mellitus. Am J Med2003;114(9):753-757.
DavisL,Vedanarayanan VV. Carpal tunnel syndrome in children. Pediatr Neurol2014;50(1): 57-59.
Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence　
by staged severity of various typesof diabetic neuropathy, retinopathy, and　nephropathy in a population-based cohort:the Rochester Diabetic NeuropathyStudy. Neurology 1993;43:817– 824.
Eadington DW, Patrick AW, Collier A, Frier BM. Limited joint mobility, Dupuytren's contracture and retinopathy in type 1 diabetes: association with cigarette smoking. Diabet Med1989; 6(2): 152-157.
Federation ID. IDF Diabetes Atlas, sixthedition, 2013.
Fitzcharles MA, Duby S, Waddell RW, Banks E, Karsh J. Limitation of joint mobility (cheiroarthropathy) in adult noninsulin-dependent diabetic patients. Ann Rheum Dis1984;43(2): 251-254.
Fitzgibbons PG,Weiss AP. Hand manifestations of diabetes mellitus. J Hand Surg Am, 2008;33(5): 771-775.
GamstedtA, Holm-Glad J, Ohlson CG, Sundstrom M. Hand abnormalities are strongly associated with the duration of diabetes mellitus. J Intern Med1993;234(2):189-193.
Gulliford MC, Latinovic R, Charlton J, Hughes RA. Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes. Diabetes Care, 2006;29(8):1929-1930.
Jennings AM, Milner PC, Ward JD. Hand abnormalities are associated with the complications of diabetes in type 2 diabetes. Diabet Med1989;6(1):43-47.
Kiani J, Goharifar H, Moghimbeigi A, Azizkhani H. Prevalence and risk factors of five most common upper extremity disorders in diabetics. J Res Health Sci2014;14(1):92-95.
Kidwai SS, Wahid L, Siddiqi SA, Khan RM, Ghauri I,Sheikh I. Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan. BMC Res Notes2013;6:16.
Kim RP.The musculoskeletal complications of diabetes. Curr Diab Rep 2002; 2(1):49-52.
King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care1998;21(9):1414-1431.
Lawson PM, Maneschi F, Kohner EM.The relationship of hand abnormalities to diabetes and diabetic retinopathy. Diabetes Care1983;6(2):140-143.
Hsieh LP, Chiang DH. The relationship between obesity and the diagnosis of carpal tunnel syndrome. Journal of Cheng Ching Medical 2005;1:39-43.
Lu YC, Wang PW, Liu RT, Tung SC, Chien WY, Hung SL, et al. Limited joint mobility of the hand: prevalence and relation to chronic complications in non-insulin-dependent diabetes mellitus patients. J Formos Med Assoc1993;92(2):139-143.
Muter BA.The Prevlanceof hand abnormalities in diabetic patients in Al.Nassiyria city and it’s association with diabetic variables. Thi-Qar Medical Journal 2011; 5(3): 28-34.
Pal B, Griffiths ID, Anderson J, Dick WC. Association of limited joint mobility with Dupuytren's contracture in diabetes mellitus. J Rheumatol1987;14(3):582-585.
Pandey A, Usman K, Reddy H, Gutch M, Jain N,Qidwai S. Prevalence of hand disorders in type 2 diabetes mellitus and its correlation with microvascular complications. Ann Med Health Sci Res2013;3(3):349-354.
Papanas N, Maltezos E.The diabetic hand: a forgotten complication? J Diabetes Complications2010;24(3):154-162.
PaduaL, Aprile I, CaliandroP, TonaliP. Is the Occurrence of Carpal Tunnel Syndrome in Men Underestimated? Epidemiology2001;12(3):369.
Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care2002;25(3):565-569.
Ramchurn N, Mashamba C, Leitch E, Arutchelvam V, Narayanan K, Weaver J, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med 2009;20(7):718-721.
Ravindran RS, Bhansali A, Walia R, Dutta P, BansalV, Shanmugasundar G.Prevalence and pattern of hand soft-tissue changes in type 2 diabetes mellitus. Diabetes Metab 2011;37(4): 312-317.
Redmond CL, Bain GI, Laslett LL, McNeil JD. Deteriorating tactile sensation in patients with hand syndromes associated with diabetes: a two-year observational study. J Diabetes Complications 2012;26(4): 313-318.
Roquelaure Y, Ha C, Rouillon C, Fouquet N, Leclerc A, Descatha A, et al. Risk factors for upper-extremity musculoskeletal disorders in the working population. Arthritis Rheum 2009; 61(10):1425-1434.
Rosenbloom AL, Grgic A, Frias JL. Diabetes mellitus, short stature and joint stiffness—a new syndrome. Pediatric Research1974; 8(4):441.
RosenbloomAL, Silverstein JH, Lezotte DC, Richardson K, McCallum M. Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N EnglJ Med 1981; 305(4):191-194.
Rosenbloom AL.Skeletal and joint manifestations of childhood diabetes. Pediatr Clin North Am 1984;31(3): 569-589.
Rosenbloom AL. Limitation of finger joint mobility in diabetes mellitus. J Diabet Complications 1989;3(2):77-87.
Shiri R. Personal and workplace risk factors for carpal tunnel syndrome. Occup Environ Med 2014;71(4):303.
Smith LL, Burnet SP, McNeil JD. Musculoskeletal manifestations of diabetes mellitus. Br J Sports Med 2003;37(1):30-35.
Starkman HS, Gleason RE, Rand LI, Miller DE, Soeldner JS. Limited joint mobility (LJM) of the hand in patients with diabetes mellitus: relation to chronic complications. Ann Rheum Dis 1986;45(2):130-135.
Tripathi BK, Srivastava AK. Diabetes mellitus: complications and therapeutics. Med Sci Monit 2006;12(7):130-147.
Vance MC,Tucker JJ, Harness NG.The association of hemoglobin A1c with the prevalence of stenosing flexor tenosynovitis. J Hand Surg Am2012; 37(9):1765-1769.
Vinik A, Mehrabyan A, Colen L, Boulton A. Focal entrapment neuropathies in
diabetes.Diabetes Care 2004;27:1783–1788.
Wei JN, Sung FC, Lin CC, Lin RS, Chiang CC, Chuang LM. National surveillance for type 2 diabetes mellitus in Taiwanese children. JAMA 2003;290:1345-1350.
Werner RA, Albers JW, Franzblau A,Armstrong TJ. The relationship between body mass index and the diagnosis of carpal tunnel syndrome. Muscle Nerve 1994;17(6): 632-636.
Yazdanpanah P, Aramesh S, Mousavizadeh A, Ghaffari P, Khosravi Z, Khademi A. Prevalence and severity of carpal tunnel syndrome in women. Iran J Public Health 2012;41(2):105-110.
Zimmet PZ. Kelly West Lecture 1991. Challenges in diabetes epidemiology--from West to the rest. Diabetes Care 1992; 15(2): 232-252.

全民健康保險研究資料庫。網址：http://nhird.nhri.org.tw/
陳建仁：流行病學：原理與方法。台北市：聯經，1999。
黃友君：糖尿病手冊-第一版。台北縣: 藝軒，2005。
行政院主計總處。2005年社會發展趨勢調查。網址：http://www.dgbas.gov.tw/lp.asp?CtNode=4793&CtUnit=1308&BaseDSD=7&mp=1
衛生福利部統計處。民102年死因統計資料。網址：http://www.mohw.gov.tw/cht/DOS/