Prevalence of adhesive capsulitis among diabetic patients in Pakistan: a systematic review and meta-analysis

Adhesive capsulitis (AC) is a debilitating musculoskeletal disorder that disproportionately affects individuals with diabetes mellitus. This association is driven by advanced glycation end-product accumulation, collagen cross-linking, and localized microvascular alterations. Despite a high clinical burden, epidemiological data concerning AC within Pakistani diabetic cohorts remain fragmented and localized. This systematic review and meta-analysis aimed to synthesize the available evidence and estimate the pooled prevalence of adhesive capsulitis among diabetic patients in Pakistan. A systematic literature search was executed across MEDLINE (via PubMed), Web of Science, Google Scholar, and localized Pakistani research repositories (PakMediNet) from database inception up to March 31, 2026. Observational studies evaluating AC prevalence in Pakistani diabetic populations were eligible. Two reviewers independently screened citations, extracted data, and appraised study quality using the Joanna Briggs Institute (JBI) critical appraisal checklist. Proportions were stabilized using the generalized linear mixed model (GLMM) with a logit transformation through the metaprop() function. Heterogeneity was determined using the I2 statistic, and sources of variation were explored via univariable meta-regression and pre-planned subgroup analyses. Certainty of evidence was rated using the GRADE approach adapted for prevalence data. Ten cross-sectional studies published between 2012 and 2025 were included, comprising a cumulative sample of 2,287 diabetic participants and 958 confirmed AC cases. The pooled prevalence of AC was 43.58% [95% CI: 29.89%, 58.33%]. Extreme statistical heterogeneity was observed across the primary literature (I2 = 97.2%, P < 0.001), which was largely driven by variations in clinical diagnostic instruments (Shoulder Pain and Disability Index, Range of Motion, and Visual Analogue Scale). Provincial subgroup analysis demonstrated comparable prevalence rates between Punjab (43.60%) and Sindh (42.35%). A significant categorical temporal effect was identified; studies published after 2020 demonstrated a higher pooled prevalence (46.85%) than older studies (31.67%). Conversely, continuous univariable meta-regression revealed no statistically significant independent association for continuous year of data collection ( P = 0.800), female proportion ( P = 0.371), or mean age ( P = 0.648). No single study disproportionately influenced the pooled estimate during leave-one-out sensitivity analysis (pooled prevalence range: 40%–48%), and no significant publication bias was detected by Begg’s ( P = 0.531) or Egger’s ( P = 0.910) tests. The certainty of evidence for the pooled prevalence was rated as very low via GRADE. Nearly half of the diabetic population in major urban regions of Pakistan represented in the literature has adhesive capsulitis. However, the pooled baseline must be interpreted cautiously due to extreme statistical heterogeneity and a total absence of data regarding rural populations or multiple provinces. Routine shoulder screening should be integrated into urban diabetic care, and future population-based studies must systematically report specific diabetes types, duration, and glycated hemoglobin (HbA1c) levels. PROSPERO (CRD420251150574). Not applicable.