Glucagon-Like Peptide-1 Receptor Agonist Use Is Associated With Decreased Incidence of Carpal Tunnel Syndrome in Patients With Type 2 Diabetes: A Propensity-Matched Analysis

Introduction: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed for glycemic control, but their relationship with diabetes-related musculoskeletal conditions remains unclear. This study compared rates of carpal tunnel syndrome (CTS), carpal tunnel release (CTR), and CTR complications in patients with type 2 diabetes mellitus (T2DM) with and without GLP-1 RA use. Methods: Adult T2DM patients were identified using the TriNetX database. The primary analysis compared patients with versus without GLP-1 RA use. The secondary analysis examined T2DM patients with CTS, stratified by GLP-1 RA exposure. The tertiary analysis included T2DM patients with GLP-1 RA use within 6 months before CTR versus controls without preoperative exposure. Cohorts were propensity-matched for demographics and comorbidities. Outcomes included CTS incidence (primary analysis), CTR incidence (secondary analysis), and 90-day postoperative complications (tertiary analysis). Results: The primary analysis identified 555 267 matched pairs. Carpal tunnel syndrome incidence was 4.8% in GLP-1 RA users versus 5.5% in nonusers (relative risk [RR] 0.886, 95% confidence interval [CI] 0.872, 0.901). Conversely, GLP-1 RA use was associated with higher CTR prevalence (RR 1.138, 95% CI 1.104, 1.174). Postoperative complication rates, including infection, wound dehiscence, complex regional pain syndrome (CRPS), and stiffness, were comparable between groups. Conclusions: Glucagon-like peptide-1 receptor agonist use was associated with reduced CTS incidence but higher CTR prevalence, without differences in postoperative complication rates. These findings suggest GLP-1 RAs may exert protective effects on musculoskeletal pathology and do not necessitate cessation before CTR.