title: Medical claims-based case-control study of temporal relationship between clinical visits for hand syndromes and subsequent diabetes diagnosis: implications for identifying patients with undiagnosed type 2 diabetes mellitus.
abstract: To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM.
  
  
  
  This study had a case-control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated.
  
  
  
  Taiwan National Health Insurance medical claims.
  
  
  
  We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis.
  
  
  
  The primary outcome measure was T2DM diagnosis.
  
  
  
  The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM.
  
  
  
  Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM.
authors: Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.|Master Program in Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.|School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.|Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan.
authors: Wen-Hsuan
authors: WH
authors: Hou
authors: Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors: Chung-Yi
authors: CY
authors: Li
authors: Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.|Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan.
authors: Lu-Hsuan
authors: LH
authors: Chen
authors: Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Liang-Yi
authors: LY
authors: Wang
authors: Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Li-Chieh
authors: LC
authors: Kuo
authors: Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
authors: Ken N
authors: KN
authors: Kuo
authors: Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors: Hsiu-Nien
authors: HN
authors: Shen
authors: Department of Dentistry, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan.
authors: Chang-Ta
authors: CT
authors: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002349:Carpal Tunnel Syndrome / Q000175:diagnosis / Q000209:etiology*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D004387:Dupuytren Contracture / Q000175:diagnosis / Q000209:etiology*; D005205:Fascia / Q000473:pathology; D005260:Female; D006225:Hand / Q000473:pathology*; D006801:Humans; D007596:Joints / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012307:Risk Factors; D013577:Syndrome; D013624:Taiwan
keywords: Diabetes related hand syndromes; Logistic regression; Nested case-control study; Type 2 diabetes; Validity