Diabetes is well known to increase the risk of complications throughout the body, potentially affecting the eyes, kidneys, and nerves.
As a result, people with diabetes are routinely monitored for conditions such as diabetic retinopathy, kidney disease, and neuropathy. This ongoing care can help prevent severe problems, such as sight loss, kidney damage, and nerve damage.
However, a new review suggests that hearing loss could be a under-recognized complications of type 2 diabetes, with many people unaware that the condition may affect hearing.
The findings, published in Diabetes Metabolism Research and Reviews, analyzed data from 29 studies involving more than 17,000 adults, most of whom had type 2 diabetes or prediabetes, and suggest they were more than twice as likely to experience clinically significant hearing loss.
Thus, the study authors propose that routine hearing tests should be incorporated as part of standard diabetes care to help identify and management hearing loss earlier.
The study was a systematic review and meta-analysis investigating the relationship between diabetes and hearing loss.
Researchers reviewed 29 observational studies published between 2000 and 2025 that involved more than 17,000 people worldwide and assessed hearing using standard audiometric tests in adults with type 2 diabetes or prediabetes.
Overall, the review found that clinically significant hearing loss was common among people living with diabetes.
Lead study author Mehwish Nisar, MD, PhD, AFHEA, a Postdoctoral Research Fellow and Affiliate of the University of Queensland Centre for Hearing Research (CHEAR), spoke to Medical News Today about why hearing loss may receive less attention as a possible complication of diabetes.
“Retinopathy, nephropathy and neuropathy are complications with established, formalised screening pathways in diabetes care, so they’re front of mind for clinicians and patients alike,” Nisar explained.
“Hearing loss has never been systematically built into those care protocols, so it’s essentially fallen through the cracks — not because the biological link isn’t real, but because it hasn’t been prioritised or measured with the same rigour,” she emphasized.
“Part of what motivated our review was that previous studies lumped together all severities of hearing loss, including very mild, subclinical changes, which may have understated how much of this burden is actually clinically significant and disabling,” the researcher told us.
Across 23 studies involving more than 5,200 people with diabetes, the researchers found that around one in four people had moderate-to-severe hearing loss.
Based on estimates from the World Health Organization (WHO), this suggests that hundreds of millions of people globally may be living with serious hearing impairment as a complication of diabetes.
When they compared data from 11 studies that included those with and without diabetes, they found that individuals with diabetes were more than twice as likely to have clinically significant hearing loss.
The researchers also looked at whether some groups were more likely to experience hearing loss than others.
They found the link between diabetes and hearing loss was strongest in adults under the age of 60, who were around three times more likely to have moderate-to-severe hearing loss than people of the same age without diabetes.
Read more:Rheumatoid arthritis, depression: How 2 conditions affect each other
The increased risk was also seen in those who had been living with diabetes for less than 10 years, suggesting hearing problems may develop earlier than previously thought.
The association was also stronger in studies from low- and middle-income countries, although the researchers said more research is necessary to understand why.
The researchers also noted differences between the studies, including the types of participants involved and the methods used to measure hearing. Despite these differences, the overall findings remained consistent.
However, because the review included observational studies, it cannot show that diabetes directly causes hearing loss; it can only show that the two are linked.
“One in four adults with diabetes has hearing loss serious enough to struggle in everyday conversation — the kind that needs hearing aids. Yet it is not on doctors’ checklists. This is a similar scale of burden to complications like retinopathy or nephropathy, which are already routinely screened for, yet hearing is not.”
– Mehwish Nisar, MD, PhD, AFHEA
“People with diabetes shouldn’t wait until hearing loss is advanced or assume it’s just ‘getting older’ — it’s worth asking their care team about a hearing check, particularly if they’re under 60 or have had diabetes for even a relatively short time,” Nisar stressed to MNT.
Although the review did not investigate the possible biological mechanisms behind the association, previous research has suggested several potential explanations.
The Centers for Disease Control and Prevention (CDC) state that hearing loss is twice as common in people with diabetes as it is in those who do not, with people with prediabetes also having a 30% higher rate of hearing loss.
Read more:U.S. men, women get equal split of $16M World Cup prize
Similar to how retinopathy or neuropathy may develop with diabetes, persistently high blood glucose levels may damage small blood vessels and delicate structures of the inner ear, as well as reduce blood flow to the ear, which could affect hearing over time.
However, more research is still necessary to understand exactly how diabetes may influence hearing health.
“Chronic high blood glucose damages the small blood vessels and nerves supplying the cochlea (the inner ear), in much the same way it damages the retina, kidneys, and peripheral nerves,” Nisar explained. “This includes microangiopathy (small vessel damage), oxidative stress, and neuropathy affecting the auditory nerve pathways.”
“Over time this cumulative cochlear damage impairs the ear’s ability to detect sound, particularly at higher frequencies, and it can progress silently, since people often don’t notice gradual hearing decline until it starts affecting daily communication,” she added.
Complications typically become more likely the longer a person has been living with diabetes. In addition to a longer duration of diabetes, increasing age is also a common risk factor for hearing loss.
However, the review found that the increased risk of hearing loss was still present among those who had been living with diabetes for fewer than 10 years.
This suggests that hearing changes may begin earlier than previously thought, and it may also be advisable for screening to occur earlier too.
Therefore, the authors suggest that routine hearing tests should be considered as part of standard diabetes care to help identify hearing loss earlier and allow people to access support sooner.
Read more:Spanish mayor cancels DR Congo World Cup tuneup over Ebola fears
The Standards of Care in Diabetes are annually updated clinical guidelines that provide best practices for preventing, diagnosing, and treating diabetes.
Healthcare for type 2 diabetes involves routine monitoring for a range of related complications, including damage to the eyes and nerves. This involves regular screening for early signs of complications and treating any problems promptly to protect vision, nerve function, and foot health.
Thus, the authors argue that hearing assessments should become a routine part of diabetes care, alongside routine screening.
Standard hearing tests are relatively simple, non-invasive, and inexpensive. Detecting hearing loss earlier could allow people to access interventions such as hearing aids sooner. This may help to reduce communication difficulties, social isolation, and their impact on daily life.
Enabling earlier detection of hearing loss in those with diabetes could prompt more frequent monitoring and management of blood glucose levels, possibly preventing further hearing loss.
“Early signs include difficulty following conversations in noisy environments, frequently asking people to repeat themselves, turning up the TV or phone volume more than usual, or feeling more fatigued after conversations because of the extra effort of listening,” said Nisar.
“Because hearing loss tends to progress gradually, people often adapt without realising there’s a problem,” she pointed out.
“If someone with diabetes notices any of these changes, they should do a pure-tone audiometric hearing test — it’s simple, low-cost, and can catch clinically meaningful hearing loss before it becomes disabling.”
Read more:Losing about 80 minutes of sleep each night linked to weight gain
While the analysis highlights a consistent association between diabetes and hearing loss, the findings are based on a review of previously published studies, and not a new clinical trial. Thus, it cannot prove that diabetes directly causes hearing impairment.
Although the results suggest that diabetes may contribute, it is also important to consider other factors may relate to hearing loss, such as age, cardiovascular disease, noise exposure, smoking, and certain medications.
The researchers note that further prospective studies are necessary to clarify the relationship and determine whether routine hearing screening improves long-term outcomes for people living with diabetes.
Still, the review adds to growing evidence that hearing health may deserve greater attention in diabetes care.
For people living with diabetes, it is advisable to discuss any changes in hearing, including difficulty following conversations, frequently asking others to repeat themselves, or needing to increase the volume on electronic devices, with a healthcare professional.
If future research confirms the benefits of routine screening, hearing assessments could eventually become another important tool for detecting complications early and helping people maintain their quality of life.
“We’d like routine audiometric screening built into standard diabetes care, the same way eye and kidney checks are,” Nisar said.
“This is especially urgent for younger adults, where the hearing loss risk was highest and least likely to be confused with normal age-related decline, and for people in low- and middle-income countries, where we found the highest risk but the least access to audiology services and hearing aids,” she concluded.
