Course of Carpal Tunnel Syndrome Management in Patients With Diabetes

Carpal Tunnel Syndrome (CTS) is the most prevalent compressive neuropathy, often worsened by microvasculopathy in diabetic neuropathy. Diabetes mellitus (DM) patients experience increased CTS risk but are frequently underdiagnosed. This study investigates the progression to CTS diagnosis and CT release (CTR) in DM patients, aimed at better early detection and CTS prevention.

Data including age and HbA1c from 304 patients with CTS, DM, and CTR (2012-2022) was collected from a tertiary care center. CTS-CTR time was compared between patients diagnosed with DM pre- or post-CTS using Wilcoxon rank-sum tests. Analyses were conducted using SAS v9.4. Relationships between age or HbA1c and CTS-CTR or DM-CTS timelines were described by Spearman correlation coefficients.

51% (n = 154) of patients received DM diagnosis post-CTS identification. Time between diagnoses was similar in patients diagnosed with DM before vs. after CTS (24.6 (8.0-41.8), 24.3 (9.9-46.2) months, p = 0.604). From CTS to first CTR, the median time difference was 2.5 months (1.0-8.1) with no significant impact from DM diagnosis timing (before: 2.57, after: 2.20 months, p = 0.188). CTS-CTR time correlated with age ( $\rho$  = -0.24, p < 0.001) and HbA1c ( $\rho$ =-0.15, p = 0.002) at CTS diagnosis. No associations occurred with age or HbA1c at DM diagnosis (age: $\rho$  = 0.03, p = 0.660, HbA1c: $\rho$  = 0.00, p = 1.00).

Over half of CTR patients were diagnosed with DM before CTS, underscoring the urgency for assessing new DM patients for CTS symptoms. Future clinical programs should target early identification of CTS signs and optimal timing for surgical interventions to enhance patient well-being.