Glucagon-like peptide-1 receptor agonists (GLP-1) are approved for type 2 diabetes treatment. Given the link between diabetes-associated metabolic inflammation and increased carpal tunnel syndrome (CTS) risk, the aim of this study was to investigate development of CTS in diabetic patients who both were and were not taking GLP-1 therapy using a large claims database.
Methods:
A retrospective cohort study used a national claims database to identify diabetic patients. Those prescribed GLP-1 therapy were matched to controls by age, sex, comorbidity index, tobacco use, and obesity. Multivariable logistic regression evaluated the 2-year CTS incidence, controlling for various health conditions and socioeconomic factors. Secondary analysis also evaluated the rate of carpal tunnel release (CTR) after being diagnosed with CTS.
Results:
Glucagon-like peptide-1 therapy significantly reduced 2-year CTS diagnosis risk (odds ratio [OR] 0.49; 95% confidence interval [CI] 0.46-0.52; P < .001). Independent risk factors for increased CTS incidence included chronic obstructive pulmonary disease, osteoarthritis, coronary artery disease, depression, hypothyroidism, and rheumatoid arthritis (RA). Of patients who developed CTS, GLP-1 therapy was associated with increased odds of undergoing CTR (OR 1.23; 95% CI: 1.08-1.41; P = .002).
Conclusions:
Glucagon-like peptide-1 therapy is associated with decreased CTS risk in diabetic patients—potentially due to improved metabolic health—and increased odds of undergoing CTR once diagnosed. Further research is needed to clarify GLP-1 therapy’s role in reducing nervous system and musculoskeletal disease burden.
MeierJJ.GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2012;8(12):728-742. doi:10.1038/nrendo.2012.140
2.
NauckMAQuastDRWefersJMeierJJ.GLP—1 receptor agonists in the treatment of type 2 diabetes—state-of-the-art. Mol Metab. 2021;46:101102. doi:10.1016/j.molmet.2020.101102
3.
ArodaVRHenryRRHanJ, et al. Efficacy of GLP-1 receptor agonists and DPP-4 inhibitors: meta-analysis and systematic review. Clin Ther. 2012;34(6):1247-1258. doi:10.1016/j.clinthera.2012.04.013
4.
PourmemariMHShiriR.Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis. Diabet Med. 2016;33(1):10-16. doi:10.1111/dme.12855
5.
MundilDCameron-VendrigAHusainM.GLP-1 receptor agonists: a clinical perspective on cardiovascular effects. Diab Vasc Dis Res. 2012;9(2):95-108. doi:10.1177/1479164112441526
6.
BestJHHoogwerfBJHermanWH, et al. Risk of cardiovascular disease events in patients with type 2 diabetes prescribed the glucagon-like peptide 1 (GLP-1) receptor agonist exenatide twice daily or other glucose-lowering therapies: a retrospective analysis of the LifeLink database. Diabetes Care. 2011;34(1):90-95. doi:10.2337/dc10-1393
7.
KidwaiSSWahidLSiddiqiSAKhanRMGhauriISheikhI.Upper limb musculoskeletal abnormalities in type 2 diabetic patients in low socioeconomic strata in Pakistan. BMC Res Notes. 2013;6:16. doi:10.1186/1756-0500-6-16
8.
ChammasMBousquetPRenardEPoirierJLJaffiolCAllieuY.Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995;20(1):109-114. doi:10.1016/S0363-5023(05)80068-1
9.
MusolinKRamseyJGWassellJTHardDL.Prevalence of carpal tunnel syndrome among employees at a poultry processing plant. Appl Ergon. 2014;45(6):1377-1383. doi:10.1016/j.apergo.2014.03.005
10.
CaglieroEApruzzeseWPerlmutterGSNathanDM.Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med. 2002;112(6):487-490. doi:10.1016/s0002-9343(02)01045-8
11.
RamchurnNMashambaCLeitchE, et al. Upper limb musculoskeletal abnormalities and poor metabolic control in diabetes. Eur J Intern Med. 2009;20(7):718-721. doi:10.1016/j.ejim.2009.08.001
12.
DahlinLBSandenHDahlinEZimmermanMThomsenNBjörkmanA.Low myelinated nerve-fibre density may lead to symptoms associated with nerve entrapment in vibration-induced neuropathy. J Occup Med Toxicol. 2014;9(1):7. doi:10.1186/1745-6673-9-7
13.
MojaddidiMAAhmedMSAliR, et al. Molecular and pathological studies in the posterior interosseous nerve of diabetic and non-diabetic patients with carpal tunnel syndrome. Diabetologia. 2014;57(8):1711-1719. doi:10.1007/s00125-014-3271-3
14.
GoldinABeckmanJASchmidtAMCreagerMA.Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation. 2006;114(6):597-605. doi:10.1161/CIRCULATIONAHA.106.621854
15.
EspositoKNappoFMarfellaR, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation. 2002;106(16):2067-2072. doi:10.1161/01.cir.0000034509.14906.ae
16.
KhalidSIMaasaraniSThomsonKB, et al. The effects of obesity and bariatric surgery on rates of upper extremity compression neuropathies. Ann Surg Open. 2022;3(1):e146. doi:10.1097/AS9.0000000000000146
17.
LawandJJTanseyPJGhaliA, et al. Glucagon-like peptide-1 receptor agonist use is associated with increased risk of perioperative complication and readmission following shoulder arthroplasty. J Shoulder Elbow Surg. 2025;34:1152-1157. doi:10.1016/j.jse.2024.09.012
18.
KimBILaValvaSMParksMLSculcoPKDella ValleAGLeeGC.Glucagon-like peptide-1 receptor agonists decrease medical and surgical complications in morbidly obese patients undergoing primary TKA. J Bone Joint Surg Am. 2025;107(4):348-355. doi:10.2106/JBJS.24.00468
19.
Koscinska-ShuklaIJaskolskaMChylinskaMJaskolskiDSieminskiMChmielewskiM.Elevated concentration of beta2—microglobulin among patients with carpal tunnel syndrome in the course of primary Sjogren syndrome—a prospective observational study on 50 patients. Rheumatol Int. 2024;44(9):1739-1747. doi:10.1007/s00296-024-05640-2
20.
Festen-SchrierVJMMAmadioPC.The biomechanics of subsynovial connective tissue in health and its role in carpal tunnel syndrome. J Electromyogr Kinesiol. 2018;38:232-239. doi:10.1016/j.jelekin.2017.10.007
21.
BarhousePSAlbrightJARebelloE, et al. Testosterone replacement therapy and associated rates of trigger finger, de Quervain tenosynovitis, and their subsequent management. J Hand Surg Am. 2024;49(6):532-540. doi:10.1016/j.jhsa.2024.01.018
22.
AlbrightJAChangKByrneRA, et al. A diagnosis of vitamin D deficiency is associated with increased rates of anterior cruciate ligament tears and reconstruction failure. Arthroscopy. 2023;39(12):2477-2486. doi:10.1016/j.arthro.2023.04.011
23.
RebelloEAlbrightJATestaEJAlsoofDDanielsAHArcandM.The use of prescription testosterone is associated with an increased likelihood of experiencing a distal biceps tendon injury and subsequently requiring surgical repair. J Shoulder Elbow Surg. 2023;32(6):1254-1261. doi:10.1016/j.jse.2023.02.122
24.
SevyJOSinaREVaracalloMA. Carpal Tunnel Syndrome. [Updated 2023 Oct 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
25.
GabrielliASLesiakACFowlerJR.The direct and indirect costs to society of carpal tunnel release. Hand (N Y). 2020;15(2):NP1-NP5. doi:10.1177/1558944718810855
26.
VinikAMehrabyanAColenLBoultonA.Focal entrapment neuropathies in diabetes. Diabetes Care. 2004;27(7):1783-1788. doi:10.2337/diacare.27.7.1783
27.
SuYCHsiehPCLaiECLinYCLinYC.Risks of carpal tunnel syndrome and carpal tunnel release surgery in users of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists: a target trial emulation study. Diabetes Metab. 2024;50(4):101545. doi:10.1016/j.diabet.2024.101545
28.
ShiriR.Hypothyroidism and carpal tunnel syndrome: a meta-analysis. Muscle Nerve. 2014;50(6):879-883. doi:10.1002/mus.24453
29.
SofatNMalikOHiggensCS.Neurological involvement in patients with rheumatic disease. QJM. 2006;99(2):69-79. doi:10.1093/qjmed/hcl005
30.
ChenSHoTAsubontengJ, et al. Risk of carpal tunnel syndrome among patients with osteoarthritis: a US population-based study. BMC Musculoskelet Disord. 2024;25(1):468. doi:10.1186/s12891-024-07459-1
31.
ChangYCChiangJHLayISLeeYC.Increased risk of coronary artery disease in people with a previous diagnosis of carpal tunnel syndrome: a nationwide retrospective population-based case-control study. Biomed Res Int. 2019;2019:3171925. doi:10.1155/2019/3171925
32.
AlsharifAAl HabbalADaaboulYAl HawatLAl HabbalOKakajeA.Is psychological distress associated with carpal tunnel syndrome symptoms and nerve conduction study findings? A case-control study from Syria. Brain Behav. 2022;12(2):e2493. doi:10.1002/brb3.2493
33.
HobbyJLVenkateshRMotkurP.The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome. J Bone Joint Surg Br. 2005;87(2):196-200. doi:10.1302/0301-620x.87b2.15055
34.
BeckerSJMakanjiHSRingD.Expected and actual improvement of symptoms with carpal tunnel release. J Hand Surg Am. 2012;37(7):1324-1329. doi:10.1016/j.jhsa.2012.03.039
35.
Lozano CalderónSAPaivaARingD.Patient satisfaction after open carpal tunnel release correlates with depression. J Hand Surg Am. 2008;33(3):303-307. doi:10.1016/j.jhsa.2007.11.025
36.
HuWSongRChengR, et al. Use of GLP-1 receptor agonists and occurrence of thyroid disorders: a meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2022;13:927859. doi:10.3389/fendo.2022.927859
37.
McDiarmidMOliverMRuserJGucerP.Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks?Environ Res. 2000;83(1):23-32. doi:10.1006/enrs.2000.4042
38.
KhosrawiSMaghrouriR.The prevalence and severity of carpal tunnel syndrome during pregnancy. Adv Biomed Res. 2012;1:43. doi:10.4103/2277-9175.100143
39.
Rotaru-ZavaleanuADLungulescuCVBunescuMG, et al. Occupational Carpal Tunnel Syndrome: a scoping review of causes, mechanisms, diagnosis, and intervention strategies. Front Public Health. 2024;12:1407302. doi:10.3389/fpubh.2024.1407302
40.
RoquelaureYGarlantézecREvanoffBADescathaAFassierJBBodinJ.Personal, biomechanical, psychosocial, and organizational risk factors for carpal tunnel syndrome: a structural equation modeling approach. Pain. 2020;161(4):749-757. doi:10.1097/j.pain.0000000000001766
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
