Rehabilitation interventions for upper limb dysfunction in type 2 diabetes mellitus, with or without diabetic peripheral neuropathy: a systematic review and meta-analysis

PURPOSE: This systematic review and meta-analysis aimed to evaluate the effectiveness of rehabilitation interventions for upper limb dysfunction in adults with type 2 diabetes mellitus (T2DM), with or without diabetic peripheral neuropathy (DPN). METHODS: Five databases were searched from inception to June 2025. Randomized controlled trials and quasi-experimental studies evaluating upper limb rehabilitation in adults with T2DM were included. Methodological quality was assessed using the PEDro scale and NIH quality assessment tools. Meta-analyses used random-effects models, with subgroup analyses by DPN status. A structured narrative synthesis summarized intervention types and outcomes. RESULTS: = 835) were included, four involving individuals with DPN. Pooled effects were not statistically significant for hand grip strength (MD = 1.58 kg; 95% CI: -0.06 to 3.22), pinch strength (MD = 0.36 kg; 95% CI: -6.80 to 7.52), or dexterity (SMD = -0.43; 95% CI: -1.61 to 0.75). Overall methodological quality was predominantly moderate, with substantial heterogeneity. Narrative synthesis suggested clinically relevant improvements, particularly with multicomponent programs combining resistance, aerobic, and functional training. CONCLUSION: Multicomponent rehabilitation programs may provide meaningful benefits for upper limb function among individuals with T2DM and should be considered in practice. High-quality, DPN-specific trials using standardized hand-focused outcomes are needed.