Background and aim of the work: Diabetic peripheral neuropathy is a major problem and a common feature of both type 1 and type 2 diabetes, as it affects approximately 60% of all persons with long-standing disease. Systematic review of the literature revealed that surgical decompression at the site of anatomic narrowing has been promoted as an optional treatment for patients with symptomatic diabetic neuropathy. This study aims to evaluate the results of median nerve decompression at the carpal tunnel in patients with painful diabetic peripheral neuropathy. Other confounders that may affect the result as diabetes duration and glycaemic state are also traced. Research design and method: Prospective study was conducted for 58 hands in 40 patients including 30 females and 10 males with an average age of 41± 5.78 years. Selection of patients from subjects attending a diabetes clinic with known neuropathy status and complained more for clinical manifestations of median nerve harm not responding to conservative treatment. All patients underwent clinical and electrophysiological assessment and patient self-administered Boston Questionnaire evaluation. The study patients were classified into two groups; group I included 34 hands in 26 patients with DPN, clinically diagnosed CTS, without electrophysiological evidence of median nerve compressive neuropathy while group II comprised 24 hands in 14 patients with DPN and clinically diagnosed CTS and superimposed compressive neuropathy on nerve conduction studies basis. Surgical decompression for the median nerve in the carpal tunnel was done for all patients. Patients were followed postoperatively at 1, 6, 12 and 24 months. Results: The Boston Questionnaire severity score showed significant improvement at the 1 month follow-up in approximately 76.47% of hands in group I and 91.67% in group II even as distal sensory and motor conduction velocities in the median nerve proved improvement in 73.53 % in group I and 91.67% in group II. Further significant improvement was found at 6 month while nearly maintained the same at 12 and 24 month. Conclusions: Diabetic Peripheral Neuropathy is a common complication of diabetes. Manifestation of median nerve neuropathy is by far the commonest of these, and gets great benefit from surgical decompression at the site of anatomic narrowing which is the carpal tunnel.