Written by: Joanne Rinker, MS, RD, CDE, LDN, AADE Director of Practice and Content Development

As a diabetes educator, when I think of diabetes complications, I think of kidney, eye, heart and nerve damage. What I don’t think about is hearing loss.THE LINK BETWEEN DIABETES AND HEARING LOSS

In 2012, a colleague brought this to my attention and asked me what screenings I do for people with diabetes (PWD) to determine if they have hearing loss. I thought about it and realized this really was never on my radar and there was nothing in place. Then she asked me to think about how a PWD might feel if they also had trouble hearing. I realized that hearing loss would not only make life more difficult for a PWD but could also lead to depression. For a PWD who is already dealing with the pressures of a very complicated disease, adding hearing impairment to the list can be potentially devastating.

I decided this was something worth discussing with other diabetes educators and began doing research. It turns out that over 29 million people in the U.S. have diabetes, and an estimated 36 million people have some type of hearing loss (17%).

In fact, the National Institutes of Health has found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. Of the almost 85 million adults thought to have pre-diabetes, the rate of hearing loss is 30% higher than in those with normal blood sugar.

The research suggests that diabetes may lead to hearing loss by damaging the nerves and blood vessels of the inner ear. Autopsy studies of diabetes patients have shown evidence of such damage.

A recent study from Henry Ford Hospital in Detroit (1) found that women between the ages of 60 and 75 with well-controlled diabetes had better hearing than women with poorly controlled diabetes, with similar hearing levels to those of non-diabetic women of the same age. The study also shows significantly worse hearing in all women younger than 60 with diabetes, even if it is well controlled.

Additionally, a 2008 study (2) showed that 54% of people with diabetes had at least mild impairment in their ability to hear high-frequency tones, compared with 32% of those with no history of diabetes. And 21% of participants with diabetes had at least mild hearing loss in low- to mid-frequency tones, compared with 9% of those without diabetes.

The Henry Ford study suggested that people with diabetes are 2.3 times more likely to have mild hearing loss, defined as having trouble hearing words spoken in a normal voice from more than three feet away.

According to the National Council on Aging, hearing loss is shown to lead to:

  • Sadness and depression
  • Increased reports of depression relative to severity of hearing loss
  • Worry and anxiety, including periods of a month or longer when they were worried, tense or anxious
  • Paranoia (“People get angry at me for no reason”)
  • Less social activity (20% less likely to participate in social activities)
  • Emotional turmoil and insecurity(3)

A Comprehensive Approach to Hearing Loss and PWD

So, what can we, as diabetes educators, do? It’s a good idea for PWD to be screened routinely for hearing loss, just as they are for eye and kidney problems. Below is a screening tool developed by the American Speech-Language-Hearing Association that can be done by a diabetes educator. The tool doesn’t require an audiologist or special equipment. If you find that your PWD score in the mild to severe impairment range, they need to be referred for more intense screening and treatment.

Treatment for hearing loss should start with a hearing aid. Typically, this will alleviate the problem. In 10% of the population, medication may also be necessary but most hearing loss is corrected with the introduction of a hearing aid. After treatment, the PWD will not only be experienced improved hearing, but will benefit in other ways, including:

  • Improved job performance
  • Improved memory
  • Improved mood
  • Less loneliness
  • Increased alertness and ability to learn new things
  • Decreased risk for personal safety
  • Increased social activity
  • Less fatigue, tension, stress, negativism, anger
  • Better relationships with their families
  • Better feelings about them selves
  • Improved mental health
  • Greater independence and security
  • Better relationships with their families
  • Better feelings about them selves
  • Improved mental health
  • Greater independence and security

As overall quality of life improves, the risk of depression declines.

So, the bottom line is to remember to add hearing loss awareness and screening to your diabetes education curriculum. Know the resources in your area and have a process to refer patients from your DSMES program to an audiologist who can do more extensive screenings as well as order and fit the patient for hearing aids. Lastly, follow up with the patient on overall quality of life. I am sure you will be surprised with how much adding this one aspect of care can benefit the lives of your PWD!

1. The study was presented recently at the Triological Society’s annual meeting in Miami Beach, Fla, Feb 2012. http://www.betterhearing.org/press/news/Diabetes_affects_hearing_loss_women_pr02232012.cfm
2. The full report is titled “Diabetes and Hearing Impairment in the United States: Audiometric Evidence from the National Health and Nutrition Examination Surveys, 1999 to 2004.” It is in the 1 July 2008 issue of Annals of Internal Medicine (volume 149, pages 1-10). The authors are K.E.Bainbridge, H.J. Hoffman, and C.C. Cowie. http://www.annals.org/content/149/1/1.abstract
3. National Council on Aging 1999 http://ihcrp.georgetown.edu/agingsociety/pdfs/hearing.pdf