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Characteristics and Outcomes of Cubital Tunnel Decompression among Diabetics Using GLP-1 Receptor Agonists
Roban Shabbir, BA
1, David Riopelle, MD
2, Simran Shamith, BS
3, Paulo E. L. Parente, MD
4, Luke T Nicholson, MD
2; Ali Azad, MD
2(1)Temple University Hospital, Philadelphia, PA, (2)Keck School of Medicine of USC, Los Angeles, CA, (3)Drexel University College of Medicine, Philadelphia, PA, (4)NYU Langone Health, New York, NY
Introduction:Cubital-tunnel release (CuTR) addresses ulnar-nerve compression; however, persistent neuropathy affects 20-35% of patients, necessitating revision surgery in approximately 7%. Type 2 diabetes mellitus (T2DM) increases the incidence and severity of ulnar neuropathy. Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs) accelerate weight loss, limit fibrosis, and promote axonal repair, potentially enhancing CuTR recovery and reducing complications. This study compares short- (90-day) and mid-term (2-year) outcomes in CuTR patients with or without perioperative GLP-1 RA exposure.
Methods:A retrospective cohort study was conducted using TriNetX, querying adults?18 years undergoing primary CuTR (CPT 64718) from 2015-2025. Cohorts included:
- Experimental cohort: Patient with T2DM with ?1 GLP-1 RA prescription 90 days pre-op and active during CuTR
- Control cohort: T2DM without GLP-1 RA prescription during CuTR
- Exclusions included T1DM, pancreatitis, MEN-2, steroid use, ESRD, or prior ipsilateral CuTR>6mo before surgery.
Propensity-score matching controlled confounders such as age, sex, BMI, HbA1c, creatinine, and prior diagnoses/procedures.
Outcomes used ICD-10-CM/CPT codes; risk ratios (RR), risk differences (RD), 95% CI, and p-values were reported.
Results:Matched cohorts included 1,766 pairs; mean age 58 years, 54% male. At 90 days, GLP-1 RA users had fewer emergency department visits (8.9% vs 10.7%, p=0.048), but higher HbA1c follow-up and values. At 2 years, GLP-1 RA exposure was associated with significantly fewer reoperations (5.2% vs 6.9%, p=0.028), reduced persistent ulnar neuropathy (23.4% vs 30.4%, p<0.001), and fewer inpatient admissions (14.6% vs 17.2%, p=0.030). Major medical complications were similar between groups, with no significant differences in contracture, infection, falls, opioid use, or late diabetic complications.
Conclusion:Perioperative GLP-1 RA use in diabetic CuTR patients was associated with improved postoperative outcomes, including reduced neuropathy recurrence, revisions, and hospitalizations. The continuation or initiation of GLP-1 RAs in diabetic CuTR candidates may result in improved long-term outcomes, particularly a decreased recurrence of neuropathy.
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