Diabetes and the risk of entrapment neuropathies of the upper and lower extremity - A propensity score-matched cohort study.

AIMS: To evaluate the association between diabetes and four peripheral nerve entrapment syndromes: carpal tunnel syndrome (CTS), ulnar nerve entrapment (UNE), radial nerve entrapment (RNE), and tarsal tunnel syndrome (TTS).

METHODS

This retrospective cohort study used the Merative™ MarketScan® Commercial Database (2007-2023). Adults ≥18 years were classified as having diabetes or serving as controls. Incident-only cohorts excluded individuals with prior diagnoses during a washout period. Propensity score matching (1:1, sex-stratified) reduced confounding, and Cox proportional hazards regression estimated time to incident diagnosis.

RESULTS

After matching, cohort sizes ranged from 6.5 to 6.8 million individuals. Diabetes was significantly associated with increased risk of all four entrapment neuropathies: CTS (HR 1.35; 95% CI 1.34-1.37), UNE (HR 1.23; 95% CI 1.21-1.24), TTS (HR 1.28; 95% CI 1.24-1.32), and RNE (HR 1.11; 95% CI 1.05-1.17; all P < 0.001). The strongest associations were observed in adults younger than 40 years with CTS (HR 1.68; 95% CI 1.63-1.73) and TTS (HR 1.56; 95% CI 1.42-1.72).

CONCLUSIONS

Diabetes is associated with increased risk across multiple anatomically distinct nerve entrapments, supporting generalized nerve vulnerability. Younger adults with diabetes may represent a high-risk subgroup warranting enhanced clinical surveillance.