Introduction

If you are anything like me, 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.  Recently a colleague and friend brought this to my attention and asked me what screenings I do for my patients to determine if they have hearing loss.  I thought about this and realized, there is nothing in place because this really was never on my radar.  Then, she asked me to think about how a patient who has diabetes might feel if they also had trouble hearing?  I started to think about how hearing loss can not only make life more difficult but it could also lead to depression.  For a diabetes patient who is already dealing with the pressures of a very complicated disease, adding hearing impairment to the list would be devastating.  So, I decided that this was something worth discussing with other diabetes educators.  I also started to do some research.  Turns out, nearly 26 million people in the U.S. have diabetes, and an estimated 36 million people have some type of hearing loss (17%).

The research

NIH has found that hearing loss is twice as common in people with diabetes as it is in those who don’t have the disease. Also, of the 79 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 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 study was done in 2008 (2) which shows that 54% of people with diabetes had at least mild hearing loss 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 their ability to hear low-to-mid frequency tones, compared with 9% of those without diabetes.

The new study suggests 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 3 feet away.

Hearing loss is shown to lead to:

1. sadness and depression
2. Increase reports of depression with severity of hearing loss
3. worry and anxiety, including periods of a month or longer when they were worried, tense or anxious
4. paranoia (“people get angry at me for no reason”)
5. Less social activity - 20% less likely to participate in social activities
6. emotional turmoil and insecurity(3)

So, what can we do? 

It's a good idea for diabetes patients to be screened routinely for hearing loss, just as they are for eye and kidney problems.  Below is an inventory that can be done by a diabetes educator because it doesn’t require an audiologist or special equipment.  If you find that you patients score in the mild to severe impairment range, they you will know that your patient needs to be referred for more intense screening and treatment. 

Treatment for hearing loss should start with a hearing aid.  Typically this will elevate 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.  At this time, the patient can now not only hear, but they have:

1. improved job performance
2. improved memory
3. improved mood
4. less loneliness
5. increased alertness and ability to learn new things. 
6. Decreased risk for personal safety. 
7. Increased social activity. 
8. Less fatigue, tension, stress, negativism, anger.
9. Better relationships with their families
10. better feelings about them selves
11. improved mental health
12. greater independence and security
13. better relationships with their families
14. better feelings about them selves
15. improved mental health
16. greater independence and security

As you can see, now that the patient is able to hear, overall quality of life has improved.  This will lead to decreased incidence of depression. 

So, the bottom line, remember to add this to your diabetes education curriculum.  Know the resources in your area and have a process to refer patients from your DSME 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 surprised how much adding this one aspect of care can benefit the lives of your patients!

Hearing Handicap Inventory for the Elderly (HHIE-S)

References

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