Nearly half of diabetic patients in Pakistan may be living with adhesive capsulitis, the painful shoulder condition commonly known as frozen shoulder, according to a systematic review and meta-analysis published in BMC Endocrine Disorders. The pooled prevalence across ten studies was 43.58 percent, with a 95 percent confidence interval of 29.89 to 58.33 percent, a wide range that the authors themselves flag as demanding caution.
The review, registered prospectively on PROSPERO, compiled cross-sectional studies published between 2012 and 2025. Together they covered 2,287 diabetic participants in Pakistan, of whom 958 had confirmed adhesive capsulitis. The researchers searched MEDLINE via PubMed, Web of Science, Google Scholar and the Pakistani repository PakMediNet up to March 31, 2026, and included observational studies that measured the prevalence of the condition in Pakistani diabetic populations.
The condition disproportionately affects people with diabetes mellitus, and the paper attributes this association to the accumulation of advanced glycation end-products, collagen cross-linking, and localized microvascular alterations. Despite this established clinical link, epidemiological data on the condition within Pakistani diabetic cohorts had remained fragmented and localized, which motivated the synthesis.
Two reviewers independently screened citations, extracted data and appraised study quality using the Joanna Briggs Institute critical appraisal checklist. To stabilize the prevalence estimates, the team used a generalized linear mixed model with a logit transformation through the metaprop function. Heterogeneity was assessed with the I2 statistic, and sources of variation were explored through univariable meta-regression and pre-planned subgroup analyses.
That heterogeneity proved extreme. The I2 statistic reached 97.2 percent with a P value below 0.001, meaning the studies differed far more than would be expected by chance alone. The authors largely attribute this variation to differences in the clinical diagnostic instruments used across the primary studies, which included the Shoulder Pain and Disability Index, range of motion assessment, and the Visual Analogue Scale. Reflecting these concerns, the certainty of evidence for the pooled prevalence was rated as very low using the GRADE approach adapted for prevalence data.
Subgroup and regression analyses produced a nuanced picture. Provincial comparisons showed comparable prevalence rates between Punjab, at 43.60 percent, and Sindh, at 42.35 percent. A categorical temporal effect emerged: studies published after 2020 reported a higher pooled prevalence of 46.85 percent, compared with 31.67 percent for older studies. However, when year of data collection was treated as a continuous variable in univariable meta-regression, no statistically significant independent association was found, with P equal to 0.800. Similarly, no significant associations were observed for the proportion of female participants, P equal to 0.371, or mean age, P equal to 0.648.
The robustness of the pooled estimate was tested in several ways. In a leave-one-out sensitivity analysis, no single study disproportionately influenced the result, with the pooled prevalence ranging from 40 to 48 percent across the analyses. Publication bias was assessed with both Begg’s and Egger’s tests, which returned P values of 0.531 and 0.910 respectively, indicating no significant evidence of bias in the published literature.
The authors conclude that nearly half of the diabetic population in major urban regions of Pakistan represented in the literature has adhesive capsulitis. They stress that the pooled baseline must be interpreted cautiously because of the extreme statistical heterogeneity and a total absence of data regarding rural populations or multiple provinces.
Based on their findings, the review recommends that routine shoulder screening be integrated into urban diabetic care in Pakistan. The authors also call for future population-based studies to systematically report specific diabetes types, disease duration, and glycated hemoglobin levels, information that was not consistently available across the included studies and that would help clarify which diabetic patients are at greatest risk.
For clinicians and researchers, the review consolidates a scattered evidence base into a single, if uncertain, national estimate. The very low certainty of the evidence and the near-total absence of rural data mean the true national picture may differ substantially, and the authors position the pooled figure as a baseline for future, more rigorous population-based research rather than a definitive measure of disease burden.
Subject of Research: Pooled prevalence of adhesive capsulitis among diabetic patients in Pakistan
Article Title: Prevalence of adhesive capsulitis among diabetic patients in Pakistan: a systematic review and meta-analysis
Article References: Khan, M., Hassan, F., Alhammad, A. A., Mushtaq, M., Abdul-Rahman, R. S., Al Kharusi, A. I., Qrmli, A. A., Youssef, A. S. A., Ahmad, M., & Muteesasira, E. (2026). Prevalence of adhesive capsulitis among diabetic patients in Pakistan: a systematic review and meta-analysis. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02705-0
Image Credits: AI Generated
DOI: 10.1186/s12902-026-02705-0
Keywords: adhesive capsulitis, frozen shoulder, diabetes mellitus, Pakistan, systematic review, meta-analysis, prevalence, heterogeneity, GRADE, cross-sectional studies, shoulder screening, BMC Endocrine Disorders
News Source: Ophelia Keating. (October 29, 2026). Frozen shoulder affects nearly half of diabetic patients in Pakistan, review finds. Scienmag.
