Dyer Brett P, Burton Claire, Rathod-Mistry Trishna, Blagojevic-Bucknall Miliça, van der Windt Danielle A
Griffith Biostatistics Unit, Griffith Health, Griffith University, Gold Coast, Queensland, Australia.
Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK.
BMC Musculoskelet Disord. 2025 May 14;26(1):471. doi: 10.1186/s12891-025-08672-2.
Estimate the effect of type 2 diabetes on the development of frozen shoulder and investigate whether the effect is mediated by other metabolic factors.
Primary care medical record-based cohort study containing 43,977 people newly diagnosed with type 2 diabetes and 43,977 without diabetes. Variables were identified using established Read codes. A weighting approach with Cox regression was used to decompose the total effect into the direct effect and indirect effect, mediated by metabolic health (which was defined as the number of metabolic factors developed during follow-up). Estimates were expressed as hazard ratios (HR). Confounders were identified using a DAG. Sensitivity to unmeasured confounding, extreme weights, and missing data were tested.
The total effect of type 2 diabetes on the development of frozen shoulder was HR = 4.38 (95% CI: 3.70-5.21), the natural indirect effect (mediated through metabolic health) was HR = 0.98 (95% CI: 0.93-1.03) and the natural direct effect was HR = 4.46 (95% CI: 3.68-5.41). Results were robust to unmeasured confounding, extreme weights, and missing data.
This study suggests that type 2 diabetes may be a cause of frozen shoulder but does not support the hypothesis that the effect is mediated by metabolic health. Clinicians should remain alert that shoulder pain in people with diabetes could be indicative of a frozen shoulder. This study should raise awareness that, despite often being overlooked, musculoskeletal conditions can be complications of diabetes and should be considered during clinical conversations with patients.
19_219R.
评估2型糖尿病对肩周炎发病的影响，并研究这种影响是否由其他代谢因素介导。
基于初级保健医疗记录的队列研究，纳入43977例新诊断的2型糖尿病患者和43977例非糖尿病患者。使用既定的Read编码识别变量。采用Cox回归加权法将总效应分解为直接效应和间接效应，间接效应由代谢健康介导（代谢健康定义为随访期间出现的代谢因素数量）。估计值以风险比（HR）表示。使用有向无环图识别混杂因素。测试了对未测量混杂因素、极端权重和缺失数据的敏感性。
2型糖尿病对肩周炎发病的总效应为HR = 4.38（95%CI：3.70 - 5.21），自然间接效应（通过代谢健康介导）为HR = 0.98（95%CI：0.93 - 1.03），自然直接效应为HR = 4.46（95%CI：3.68 - 5.41）。结果对未测量混杂因素、极端权重和缺失数据具有稳健性。
本研究表明2型糖尿病可能是肩周炎的一个病因，但不支持该效应由代谢健康介导的假设。临床医生应保持警惕，糖尿病患者的肩部疼痛可能提示肩周炎。本研究应提高人们的认识，即尽管肌肉骨骼疾病常常被忽视，但它们可能是糖尿病的并发症，在与患者的临床交流中应予以考虑。
ISAC协议注册号：19_219R。
