The Science of Diabetes Self-Management and Care2024, Vol. 50(5) 406–417© The Author(s) 2024Article reuse guidelines:sagepub.com/journals-permissionsDOI: 10.1177/26350106241268383journals.sagepub.com/home/tde
AbstractPurpose: The purpose of this study was to assess the combined effects of type 2 diabetes (T2D) and hearing loss on the level of distress in individuals with diabetes.
Methods: The 2021 National Health Interview Survey included 2633 adults (ages 18+) with T2D who reported perceived hearing loss, level of diabetes-related distress, household composition, and demographic characteristics. Logistic regressions evaluated these association between hearing loss and diabetes distress controlling for age, income, region of residence, marital status, rurality, educational attainment, insurance coverage, time since diabetes diagnosis, and household composition. Interaction effects examined differential associations between demographic groups.
Results: About 3.5% of adults with T2D in the sample reported hearing loss, and 70% reported diabetes-related distress. Results indicated that diabetes distress was significantly more likely among individuals with hearing loss (OR = 2.08) relative to their hearing counterparts. Additionally, females (OR = 1.50), low-income earners (OR = 1.84), middle-income earners (OR = 1.41), non-Hispanic Blacks (OR = 1.58), and Hispanics (OR = 1.75) with diabetes had higher odds of reporting diabetes distress. Interaction analyses indicated that non-Hispanic Blacks and Hispanics with hearing loss had a 37% and 19%, respectively, higher likelihood of diabetes distress relative to non-Hispanic Whites with hearing loss.
Conclusion: Diabetes distress was more likely among individuals with hearing loss. These findings suggest the communication challenges of individuals with hearing loss may explain the observed differences in distress.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, diabetes distress is one emotional response to living with diabetes, a life-threatening illness that requires chronic, demanding self-management.1,2 Research suggests that between 30% and 40% of adults with diabetes are likely to report significant levels of diabetes distress over time.3 People who report more diabetes distress are also more likely to report more problems with selfmanagement and medication adherence and may also have higher blood glucose levels.4 They are also more likely to experience hypoglycemia, fear of hypoglycemia, and intermittent inability to take their medications.5
Understanding the nature of diabetes distress is critically important because the condition is associated with negative health-related outcomes.6 A major concern lies in the requirements of diabetes self-management, which become increasingly difficult when coexisting conditions, such as diabetes distress, are present.7 There are other conditions, such as hearing loss, that also magnify the negative impact of diabetes and burden of self-management.8 Type 2 diabetes (T2D) has been significantly associated with hearing loss in multiple large-scale, population-based studies9-11 and several smaller studies focusing on population subgroups, such as the elderly or those located in specific geographic areas or care centers.12,13
It is also notable that both hearing loss and diabetes have their own risk factors (genetics, exposure to noise, trauma) yet share others with diabetes (age, medications, etc).14 To date, a specific causal link has not been identified between diabetes and hearing loss despite studies consistently showing the incidence of hearing loss among individuals with diabetes is twice that of those without the condition.15 Gioacchini et al8 proposed that specific physio-pathological mechanisms cause damage to specific hearing structures. Proposed pathways for the association between diabetes and hearing loss appear to stem from the combined impact of hyperglycemia and oxidative stress,16,17 which has also been shown to cause cochlear microangiopathy,18 auditory neuropathy,19,20 and subsequent hearing loss. Finally, the pharmacological management approaches used in diabetes management may also contribute to hearing loss.8 Despite the independent negative contributions of both distress and hearing loss among individuals with diabetes, the association between the conditions and their role in diabetes self-management is not entirely understood. The objective of this project was to examine the relationship between hearing loss and diabetes distress among a nationally representative sample of US adults with T2D. This study was designed to examine the relationship between hearing loss and diabetes distress and test for differential associations by sex, race-ethnicity, and income level.
This study employed a cross-sectional study design to assess the association between diabetes distress and hearing loss and determine the relative prevalence between demographic groups using nationally representative survey data.
Data for this study came from the 2021 National Health Interview Survey (NHIS)21—an annual household interview survey of the US civilian, noninstitutionalized population sponsored by the National Center for Health Statistics and the Centers for Disease Control and Prevention. Households were selected for the NHIS using a complex, multistage probability design; therefore, samplings weights were used to account for selection probabilities and nonresponse patterns, allowing estimates to reflect a nationally representative population. The NHIS collects information on respondents’ sociodemographic characteristics, health status and activity limitations, behavior indicators, and health care access and utilization. A major strength of this survey lies in the ability to display these health characteristics by many demographic and socioeconomic characteristics. Although the NHIS annual questionnaire content remains relatively unchanged each year, questions related to diabetes distress were removed after 2021 (reflected in the 2022 data release). Thus, 2021 is the most recently released survey that contains the questions necessary to evaluate factors associated with diabetes distress. Specific survey items are outlined in the following.
Among the 29 208 adult respondents to the 2021 NHIS, 2633 reported T2D, and 245 and 65, respectively, reported having been diagnosed with type 1 diabetes or another type/type unknown. Due to differences in the cause, onset, and treatment of diabetes types, analysis was limited to respondents with T2D.
All NHIS respondents were asked, “Has a doctor or other health professional told you that you had diabetes (not including gestational diabetes, prediabetes)?” Individuals answering affirmatively were asked a series of follow-up questions regarding their diagnosis, including time since diagnosis (in years), diabetes type (type 1, type 2, some other type), and level of diabetes distress. Diabetes distress22—defined as patient concerns about disease management, support, emotional burden, and access to care—was assessed using a 1-item screening adapted from the 17-item Diabetes Distress Scale.22 Respondents indicated, “During the past month, how often have you felt overwhelmed by the demands of living with diabetes? Would you say always, usually, sometimes, rarely, or never?” For this analysis, response categories were collapsed into 2 groups—distress (always, usually, sometimes) and no distress (rarely, never).
Respondents characterized their level of hearing ability as no difficulty hearing, some difficulty hearing, a lot of difficulty hearing, or cannot hear at all. A binary indicator was created by collapsing response categories into 2 groups—(1) no difficulty, some difficulty and (0) a lot of difficulty, cannot do at all—to create a binary indicator.
Individual characteristics included respondent’s sex at birth, age, marital status (married, unmarried), educational attainment (less than high school graduation, high school graduate/some college/technical or vocational degree, college degree or above), region of residence (Northeast, Midwest, South, West), rurality (large metropolitan, medium/small metropolitan, nonmetropolitan), insurance type (Medicare, Medicaid, private, no insurance), and self-identified race/ethnicity. NHIS classified race and ethnicity as Hispanic, non-Hispanic White only, non- Hispanic Black/African American only, non-Hispanic Asian only, non-Hispanic American Indian/Alaska Native (AIAN) only, non-Hispanic AIAN and any other group, and other single and multiple races. Sample size limitations precluded individual analyses of all available racial and ethnic groups; therefore, non-Hispanic Asian only, non-Hispanic AIAN only, non-Hispanic AIAN and any other group, and other single and multiple races were combined into a single category. Finally, income-to-poverty ratio (IPR), a continuous value ranging between 0 and 5, indicated the level of household earnings relative to the prevailing poverty threshold. As opposed to nominal earnings, IPR implicitly adjusts for geographic variations in cost of living and price changes. Furthermore, poverty thresholds vary by the size of the family and the age of household members. A value of 0 indicates no earned income. and larger values represent indicated ratios rather than providing continuous values. NHIS translated household IPR into discrete indicators of respondents’ position in the IPR distribution. These indicators were used to form 3 income groups: low (IPR < 2.00), middle (2.00 ≤ IPR < 4.00), and high (4.00 ≤ IPR < 5.00).
Of the 29 208 adult respondents, 2633 reported T2D, and 245 and 65, respectively, reported having been diagnosed with type 1 diabetes and another type/type unknown. Due to differences in the cause, onset, and treatment of diabetes types, analysis was limited to respondents with T2D. Before evaluating the association between diabetes distress and hearing loss, the sample characteristics including demographic, household, and hearing-related components were first examined. Then these characteristics were compared between those who did and did not experience hearing loss using t and chi-square test for continuous and categorical outcomes, respectively. Second, logistic regression evaluated the association between diabetes distress, individual-level characteristics, and hearing loss. Finally, differences in the association between diabetes distress and hearing loss between sex, rurality, income, and racial/ethnic cohorts were tested through the inclusion of interaction terms. Odds ratios were calculated for all model covariates and interactions. Because NHIS used a complex, multistage probability sampling design that incorporated stratification, clustering, and oversampling of some subpopulations, all estimates incorporated sampling weights. allowing them to reflect the civilian, noninstitutionalized population. To accurately estimate standard errors, analyses utilized nesting variables that captured the explicit stratification and clustering of the survey respondents.
Mean and frequency values for all sample characteristics are listed in Table 1 for the full sample of adults with T2D and those with and without hearing loss. Respondents were 62.8 (SE = 0.32) years old, on average. Just over half (51%) of respondents were male, and 59% were married. They lived in all regions of the United States (15.2% Northeast, 20.6% Midwest, 43.4% South, 20.8% West), and 51.1% were in large, metropolitan areas. Less than 10% did not have a high school degree, and 33.9% had achieved a college degree or beyond. About 35% of the sample had a household income below 200% of the federal poverty level. Roughly 18% of respondents were Hispanic, with 57.7%, 16.4%, and 8.2% being White, Black, and Asian/other/multiple racial, respectively. Nearly 70% of individuals with T2D indicated that they experienced diabetes distress always, usually, or sometimes.
Most respondents (96.5%) reported that they had no difficulty hearing, while 3.5% reported hearing loss. Most tests comparing the characteristics of individuals with and without hearing loss indicated no statistically significant differences between the 2 groups. There were, however, more individuals with hearing loss insured by Medicare (59.9%) compared to those without difficulty (48.8%, χ2 = 9.97, P = 0.00). Only 45.7% of the sample with hearing loss were married, compared to 59.4% of those without hearing loss (χ2 = 5.00, P = 0.03). Finally, the portion of the sample with hearing loss had a larger portion of low-income earners (43.7% vs 34.7, χ2 = 13.93, P = 0.00) and individuals living in nonmetropolitan areas (30.2% vs 15.4%, χ2 = 12.00, P = 0.00) compared to the sample without hearing loss.
Logistic regression results of the association between diabetes distress, hearing loss, and individual characteristic are listed in Table 2. The likelihood of experiencing diabetes distress was significantly higher among females (OR = 1.50, 95% CI, 1.21-1.85) compared to males but slightly lower for older respondents (OR = 0.96, 95% CI, 0.95-0.97). Relative to White respondents, Hispanic (OR = 1.75, 95% CI, 1.20-2.54), Black (OR = 1.58, 95% CI, 1.14-2.19), and Asian/other/multi respondents (OR = 1.54, 95% CI, 1.04-2.29) were more likely to experience diabetes distress, and relative to high income earners, respondents in low (OR = 1.84, 95% CI, 1.32-2.56) and middle (OR = 1.41, 95% CI, 1.06-1.88) income were also comparatively more likely. Even after controlling for age, insurance, years living with the condition, and income, individuals with hearing loss (OR = 2.08, 95% CI, 1.17-3.69) were over twice as likely as those without difficulty to indicate diabetes distress.
Three additional regression models were run that included interactions between hearing loss and income (Table 3), sex (Table 4), and racial/ethnic (Table 5) indicators. Statistically significant interaction terms indicated a differential likelihood of diabetes distress between the respondents in the interacted group who reported hearing loss and the respondents who did not. Neither sex nor income interaction effects reached statistical significance, suggesting no differential association between hearing loss and the likelihood of diabetes distress between subgroups. However, racial and ethnic groups did show a difference. Relative to White respondents with hearing loss, Black respondents (OR = 1.37, 95% CI, 1.02-1.79) and Hispanic respondents (OR = 1.19, 95% CI, 1.05-1.34) with hearing loss were significantly more likely to report diabetes distress.
In this study of adults with diabetes, findings showed that those with hearing loss were more likely to report diabetes distress than those without hearing loss. These findings are important because diabetes is a chronic condition independently associated with hearing loss9-11,15,23 and similarly, hearing loss is independently associated with emotional distress, social isolation, depression,24,25 and other age-related issues, such as increased prevalence of cognitive decline, hospitalizations, and mortality.26 According to Gioacchini et al,8 a complex relationship exists between diabetes and hearing loss because the disease-related microvascular and macrovascular insults, alternations in oxygen exchange, and ion transport associated with diabetes is believed to have a direct impact on cochlear cells critical to hearing.
To date, the specific mechanisms underlying hearing loss in diabetes are not entirely understood, and consequently, it is less clear how the combination of diabetes and hearing loss contributes to diabetes distress. When considering that diabetes distress is an emotional response to the condition resulting in feelings of frustration, being defeated, or overwhelmed, one must also consider that hearing loss itself is also negatively associated with feelings of psychological distress and declines in subjective well-being. The finding here suggests that diabetes distress may be further magnified in individuals with both diabetes and hearing loss, thereby compounding the overall impact of the condition. These findings are also important for understanding that factors that contribute to quality of life because both individuals with hearing loss and those with diabetes distress are also more likely to report reductions in quality of life than their hearing counterparts and those absent of diabetes distress.
A second and very interesting finding was related to racial-ethnic disparities in the relationship between diabetes distress and hearing loss. This study showed that relative to Whites with hearing loss, Blacks and Hispanics with hearing loss were significantly more likely to report diabetes distress. Regarding hearing loss specifically, the existing literature is mixed when exploring the presence of racial disparities and hearing loss.27,28 In studies of racial disparities in diabetes distress, the evidence consistently suggests Blacks are more likely to experience diabetes distress.29,30 Similarly, diabetes distress among Blacks is associated with worse clinical outcomes,29 and even when positive associations existed between diabetes distress and self-care activities, less than adequate self-care was observed among Blacks with moderate to high levels of distress.31 Thus, the broader question is whether the combination of hearing loss, diabetes, and race/ethnicity has an additive or synergistic impact on diabetes self-management or contributes to poorer diabetes outcomes among Blacks. Additionally, how do providers and patients address the issue of diabetes, hearing loss, and diabetes distress to minimize the consequences of each condition.32
This interesting study faced several limitations, and findings presented herein should be interpreted in the appropriate context. First, this study utilized data reported in 2021 and cannot account for changes in individual circumstances, health care infrastructure, and insurance coverage provisions that have occurred more recently. Although no dramatic changes in treatment and/or coverage regulations have occurred more recently, health technology and policy are rapidly evolving and innovating. Second, this analysis was able to account for neither individual-level glycemic index nor the receipt of treatment for these conditions. Receipt of unobserved health services for T2D and/or hearing loss may have biased results. Third, although this study accounted for having health insurance, it was not possible to evaluate differences in health insurance coverage limitations. Fourth, there were fewer than 100 respondents reporting both diabetes distress and hearing loss—a factor limiting broader interpretation and generalization.
Fifth, all data used in this study were self-reported, including diabetes diagnosis, diabetes distress, and hearing difficulty. Self-reported data are known to suffer from recency, favorability, and recall bias, which cannot be controlled in this type of large-scale study. Additionally, NHIS includes neither specific information related to preferences or beliefs about hearing loss or treatment of the condition that could explain some of the observed differences nor information related to environmental factors that have been shown to influence hearing loss and access to treatment.33 Some studies have shown that self-reported level of hearing loss tends to overestimate the severity of the impairment.33 Similarly, NHIS is not based on the professional hearing evaluations or account for genetic contributions to hearing loss or noise exposures.34
Sixth, the relationship between the duration of diabetes and hearing loss is unclear. Although Weng et al35 and Bener et al36 showed that the mean duration of diabetes was 7.5 to 7.7 and 7.8 (±4.12) years, respectively, before onset of hearing loss, Mozaffari et al37 found that the duration was significantly longer, and Dalton et al38 indicated that there was no association. Finally, it was not possible to account for the potential association between the level of glycemic control and the severity of hearing loss. Although some studies have shown no significant differences in hearing levels between individuals with and without T2D,39 some evidence suggests that individuals with diabetes experience more severe hearing loss relative to their nondiabetic counterparts40 and that the likelihood and level of hearing loss is more severe for those with poor controlled glycemia.41
Diabetes is a complex, systemic disease that can impact widespread body tissues and physiological functions on molecular and biochemical levels. As demonstrated in this study, there is a strong association between hearing loss and the level of diabetes distress among those with T2D, particularly Blacks and Hispanics. Although causality is outside the scope of this analysis, a more complete understanding of the intersectional relationship between lifestyle, environment, and hyperglycemia on sensory organs could lead to clinical interventions and development of diagnostic indicators that could prevent the exacerbation of diabetes-related distress.
MJ researched data and cowrote the first draft of the article. CE cowrote the first draft of the article. Both authors approved the final version of the article.
The authors have no conflicts of interest.
None.
Molly M. Jacobs https://orcid.org/0000-0001-5943-8507
Skinner TC, Joensen L, Parkin T. Twenty-five years of diabetes distress research. Diabet Med. 2020;37(3):393-400. doi:10.1111/dme.14157
Dennick K, Sturt J, Speight J. What is diabetes distress and how can we measure it? A narrative review and conceptual model. J Diabetes Complications. 2017;31(5):898-911. doi:10.1016/j.jdiacomp.2016.12.018
Verdecias N, McQueen A, Von Nordheim DA, Broussard DJ, Smith RE, Kreuter MW. Diabetes distress in a Medicaid sample: the role of psychosocial and health-related factors. J Diabetes Complications. 2023;37(7):108495. doi:10.1016/j.jdiacomp.2023.108495
Schmitt A, Bendig E, Baumeister H, Hermanns N, Kulzer B. Associations of depression and diabetes distress with selfmanagement behavior and glycemic control. Heal Psychol. 2021;40(2):113-124. doi:10.1037/hea0001037
Hoogendoorn CJ, Schechter CB, Llabre MM, Walker EA, Gonzalez JS. Distress and type 2 diabetes self-care: putting the pieces together. Ann Behav Med. 2021;55(10):938-948. doi:10.1093/abm/kaaa070
Kreider KE. Diabetes distress or major depressive disorder? A practical approach to diagnosing and treating psychological comorbidities of diabetes. Diabetes Ther. 2017;8(1):1-7. doi:10.1007/s13300-017-0231-1
Devarajooh C, Chinna K. Depression, distress and self-efficacy: the impact on diabetes self-care practices. PLoS One. 2017;12(3):e0175096. doi:10.1371/journal.pone.0175096
Gioacchini FM, Pisani D, Viola P, et al. Diabetes mellitus and hearing loss: a complex relationship. Medicina (B Aires). 2023;59(2):269. doi:10.3390/medicina59020269
Bainbridge KE, Hoffman HJ, Cowie CC. Risk factors for hearing impairment among U.S. adults with diabetes. Diabetes Care. 2011;34(7):1540-1545. doi:10.2337/dc10-2161
Genther DJ, Betz J, Pratt S, et al. Association of hearing impairment and mortality in older adults. J Gerontol A Biol Sci Med Sci. 2015;70(1):85-90. doi:10.1093/gerona/glu094
Gupta S, Eavey RD, Wang M, Curhan SG, Curhan GC. Type 2 diabetes and the risk of incident hearing loss. Diabetologia. 2019;62(2):281-285. doi:10.1007/s00125-018-4766-0
Lerman-Garber I, Cuevas-Ramos D, Valdés S, et al. Sensorineural hearing loss—a common finding in early-onset type 2 diabetes mellitus. Endocr Pract. 2012;18(4):549-557. doi:10.4158/EP11389.OR
Ren J, Ma F, Zhou Y, et al. Hearing impairment in type 2 diabetics and patients with early diabetic nephropathy. J Diabetes Complications. 2018;32(6):575-579. doi:10.1016/j.jdiacomp.2018.03.014
Samocha-Bonet D, Wu B, Ryugo DK. Diabetes mellitus and hearing loss: a review. Ageing Res Rev. 2021;71:101423. doi:10.1016/j.arr.2021.101423
Bainbridge KE, Hoffman HJ, Cowie CC. Diabetes and hearing impairment in the United States: audiometric evidence from the national health and nutrition examination survey, 1999 to 2004. Ann Intern Med. 2008;149(1):1-10. doi:10.7326/0003-4819-149-1-200807010-00231
Aladag İ, Eyibilen A, Güven M, Atış Ö, Erkokmaz Ü. Role of oxidative stress in hearing impairment in patients with type two diabetes mellitus. J Laryngol Otol. 2009;123(9):957-963. doi:10.1017/S0022215109004502
Akbar A, Kamalakshi TV, Thulaseedharan NK, et al. Audiometric assessment of hearing loss and its association with oxidative stress in patients with type 2 diabetes mellitus. Natl J Physiol Pharm Pharmacol. 2019;9(6):1. doi:10.5455/njppp.2019.9.0102122032019001
Fukushima H, Cureoglu S, Schachern PA, Paparella MM, Harada T, Oktay MF. Effects of type 2 diabetes mellitus on cochlear structure in humans. Arch Otolaryngol Neck Surg. 2006;132(9):934. doi:10.1001/archotol.132.9.934
Ciorba A, Aimoni C, Bovo R. Hearing loss and diabetes mellitus: evidences of cochlear microangiopathy? Audiol Med. 2012;10(3):105-108. doi:10.3109/1651386X.2012.709352
Lisowska G, Namysłowski G, Morawski K, Strojek K. Cochlear dysfunction and diabetic microangiopathy. Scand Audiol. 2001;30(1):199-203. doi:10.1080/010503901300007524
National Center for Health Statistics. National health interview survey questionnaire. National Center for Health Statistics. Published 2000. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Survey_Questionnaires/NHIS/2021/EnglishQuest.pdf
Polonsky WH, Fisher L, Earles J, et al. Assessing psychosocial distress in diabetes. Diabetes Care. 2005;28(3):626-631. doi:10.2337/diacare.28.3.626
Cheng P, Gilchrist A, Robinson KM, Paul L. The risk and consequences of clinical miscoding due to inadequate medical documentation: a case study of the impact on health services funding. Heal Inf Manag J. 2009;38(1):35-46. doi:10.1177/183335830903800105
Gopinath B, Hickson L, Schneider J, et al. Hearing-impaired adults are at increased risk of experiencing emotional distress and social engagement restrictions five years later. Age Ageing. 2012;41(5):618-623. doi:10.1093/ageing/afs058
Theodoropoulou KT, Dimitriadis GD, Tentolouris N, Darviri C, Chrousos GP. Diabetes distress is associated with individualized glycemic control in adults with type 2 diabetes mellitus. Hormones. 2020;19(4):515-521. doi:10.1007/s42000-020-00237-3
Trott M, Smith L, Xiao T, et al. Hearing impairment and diverse health outcomes. Wien Klin Wochenschr. 2021;133(19-20):1028-1041. doi:10.1007/s00508-021-01893-0
Lin FR, Niparko JK, Ferrucci L. Hearing loss prevalence in the United States. Arch Intern Med. 2011;171(20):1851-1853.
Helzner EP, Cauley JA, Pratt SR, et al. Race and sex differences in age-related hearing loss: the health, aging and body composition study. J Am Geriatr Soc. 2005;53(12):2119-2127. doi:10.1111/j.1532-5415.2005.00525.x
Helgeson VS, Naqvi JB, Korytkowski MT, Gary-Webb TL. A closer look at racial differences in diabetes outcomes among a community sample: diabetes distress, self-care, and HbA1c. Diabetes Care. 2021;44(11):2487-2492. doi:10.2337/dc21-0734
Butler AM, Brown SD, Carreon SA, Smalls BL, Terry A. Equity in psychosocial outcomes and care for racial and ethnic minorities and socioeconomically disadvantaged people with diabetes. Diabetes Spectr. 2022;35(3):276-283. doi:10.2337/dsi22-0006
Nesbitt JC, Putnam JB Jr, Walsh GL, Roth JA, Mountain CF. Survival in early-stage non-small cell lung cancer. Ann Thorac Surg. 1995;60(2):466-472.
Sewell HE, Planas LG, Brown MR, et al. Diabetes and hearing impairment: knowledge, attitudes, and practices among providers and patients. Sci Diabetes Self Manag Care. 2024;50(3):201-210. doi:10.1177/26350106241250291
Nieman CL, Marrone N, Szanton SL, Thorpe RJ Jr, Lin FR. Racial/ethnic and socioeconomic disparities in hearing health care among older Americans. J Aging Health. 2016;28(1):68-94.
Hoffman HJ, Dobie RA, Losonczy KG, Themann CL, Flamme GA. Declining prevalence of hearing loss in US adults aged 20 to 69 years. JAMA Otolaryngol Neck Surg. 2017;143(3):274-285.
Weng S, Chen Y, Hsu C, Tseng F. Clinical features of sudden sensorineural hearing loss in diabetic patients. Laryngoscope. 2005;115(9):1676-1680. doi:10.1097/01.mlg.0000184790.91675.e3
Bener A, Al-Hamaq AOAA, Abdulhadi K, Salahaldin AH, Gansan L. Interaction between diabetes mellitus and hypertension on risk of hearing loss in highly endogamous population. Diabetes Metab Syndr. 2017;11(suppl 1):S45-S51. doi:10.1016/j.dsx.2016.09.004
Mozaffari M, Tajik A, Ariaei N, Ali Ehyaii F, Behnam H. Diabetes mellitus and sensorineural hearing loss among nonelderly people. East Mediterr Health J. 2010;16(9):947-952.
Dalton AF, Bunton AJ, Cykert S, et al. Patient characteristics associated with favorable perceptions of patient–provider communication in early-stage lung cancer treatment. J Health Commun. 2014;19(5):532-544. doi:10.1080/10810730.2013.821550
Park E, Shim J, Choi SJ, Jung HH, Im GJ. Effects of glycemic control on hearing outcomes in diabetes patients with idiopathic sudden sensorineural hearing loss. J Int Adv Otol. 2021;17(2):109-114. doi:10.5152/JIAO.2021.9276
Mitchell P, Gopinath B, McMahon CM, et al. Relationship of type 2 diabetes to the prevalence, incidence and progression of age-related hearing loss. Diabet Med. 2009;26(5):483-488. doi:10.1111/j.1464-5491.2009.02710.x
Sunkum AJK, Pingile S. A clinical study of audiological profile in diabetes mellitus patients. Eur Arch Otorhinolaryngol. 2013;270(3):875-879. doi:10.1007/s00405-012-2063-y
From Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida (Dr Jacobs); and Department of Speech Language and Hearing Sciences, College of Public Health and Health Professions, University of Florida, Gainesville, Florida (Dr Ellis).
Corresponding Author:Molly M. Jacobs, Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, 1225 Center Drive, Gainesville, FL 32610, USA.Email: mollyjacobs@ufl.edu