Introduction: The impact of Diabetes Mellitus (DM) medications on compressive neuropathy remains underexplored. This study examines how DM medications impact the prevalence of median, ulnar, sciatic, and peroneal neuropathies, as well as surgical outcomes for Carpal Tunnel Syndrome (CTS), including wound dehiscence, incision and drainage, and antibiotic use.
Methods: TriNetX Research Network was utilized to compare neuropathy outcomes for patients on Metformin vs. GLP-1 analogs (Analysis A), sulfonylureas (Analysis B), or short-acting insulin (Analysis C). For surgical outcomes, median nerve surgery was added as an inclusion criterion. Propensity score matching included demographics, endocrine/metabolic disorders, and mononeuropathies.
Results: Patients on sulfonylureas or insulin had a lower risk of neuropathies vs. Metformin, except for non-significant ulnar and peroneal neuropathies hazard ratios (HR) in Analysis C. Most HR in Analysis A were non-significant, except for CTS, which favored Metformin. Hemoglobin A1C values in Analysis A, B, and C for Metformin vs. other DM medication demonstrated significant findings (p < 0.01) and were 7.121% vs. 7.305%, 6.958% vs. 7.098%, and 7.079% vs. 7.507%, respectively. For CTS surgical outcomes, Analysis A HR (95% CI) for wound dehiscence were 1.725 (1.108, 2.687) at 30-days and 1.481 (1.048, 2.094) at 90-days, while Analysis C HR (95% CI) were 0.493 (0.373, 0.651) at 30-days and 0.479 (0.381, 0.602) at 90-days. Analysis C also demonstrated reduced antibiotic use in the metformin group with a HR (95% CI) of 0.339 (0.314, 0.366) at 30-days and 0.481 (0.455, 0.509) at 90-days. Hemoglobin A1c values were significantly lower for Metformin in all analyses.
Conclusion : Our findings indicate that metformin was generally not associated with reduced neuropathy prevalence compared to sulfonylureas and insulin. Metformin showed improved surgical outcomes over insulin for antibiotic use and wound dehiscence at both time points. GLP-1 was linked to fewer post-surgical wound dehiscence complications than metformin despite higher hemoglobin A1c levels
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