Disclosures: Rinker reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.
January 06, 2021
4 min read
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Hearing loss in diabetes often remains undiscussed

Disclosures: Rinker reports no relevant financial disclosures. Weiner reports she is a clinical adviser to Livongo Health.
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In this issue, Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with the director of practice and content development at the Association of Diabetes Care & Education Specialists, Joanne Rinker, MS, RDN, CDCES, LDN, FADCES, about the need to identify and manage hearing loss in diabetes care.

How common is hearing loss in people with diabetes?

Susan Weiner
Joanne Rinker

Rinker: It is more common than you might think. There are 34 million U.S. residents with diabetes and about 34.5 million people with hearing loss. Many of those double up. For people who have prediabetes, the rate of hearing loss is 30% higher, and for those who have diabetes, it is twice as common as for those who do not have diabetes. Additionally, hearing loss in a person with diabetes often presents earlier than in those without diabetes, and the risk increases when that person also has co-conditions, such as neuropathies, high blood pressure and cardiovascular disease.

Infographic. Six questions to screen for hearing loss in diabetes.

What causes these higher rates of hearing loss among people with diabetes?

Rinker: When you think about the damage that elevated blood glucose has on the other small vessels in the body, the ear is very similar. When glucose levels are high, the small vessels in the inner ear start to break. Those broken blood vessels disrupt normal hearing.

Over the last 9 years, I have learned so much about this connection and how important it is to assist people with diabetes and hearing loss so that they can improve their quality of life while also decreasing risks associated with diabetes. We know that hearing loss is gradual, and while hearing is diminishing, so is the person’s ability to process speech. Over time, not only does a person lose the ability to hear clearly, they are also losing the ability to process the words and sentences being said by their family, friends and colleagues. The good news is that our specialty is poised to screen and advocate for treatment of the populations we serve.

What can the diabetes care and education specialists (DCES) do to make an impact on hearing health?

Rinker: It is very important that the DCES add this screening to their initial assessment and annual follow-up. There is a simple six-question screening (see Infographic) that can be done in the office while a person is waiting to be seen. Based on the results, the DCES can choose to make a referral as needed. For this to be a successful process, the DCES must take the time to build a relationship with an audiologist. To find an audiologist in your area, use this link: www.audiologist.org/patients/find-an-audiologist.

How often should screenings be done?

Rinker: An initial screening should be done when a person is diagnosed with diabetes. This allows the DCES to get a baseline and assess whether a referral is needed. If this screening is then done annually, any level of hearing loss is caught early.

This is why I have been so passionate about making sure more DCES include hearing screenings in their practice. The longer a person with hearing loss goes untreated, the longer they are losing the ability to process speech. If you know someone with hearing loss, you may try to speak louder so you can be heard. When someone has had prolonged hearing loss, what they actually need is for you to slow down and to repeat yourself so they can go through the process of recognizing words and their definitions to understand what you are asking or communicating. But to get to this point, they’d have to be treated first for whatever level of hearing loss they are experiencing.

How is that level determined?

Rinker: The level of hearing loss is measured by decibel. My favorite depiction of this is with Down’s Audiogram, which can be found at cid.edu/wp-content/uploads/2016/05/CID-AUDIOGRAM-ENGLISH.pdf. The great thing about this graphic is that people with hearing loss can look at this and understand what it means they can and can’t hear. They’ll be able to see what they can’t hear as they decrease in decibels and/or frequencies.

How is hearing loss treated?

Rinker: The most common treatment — in more than 90% of cases — is hearing aids. A person would want to be sure they are fit for the appropriate hearing aid so they are comfortable and willing to wear them persistently. Once a person has hearing aids, they will be begin exercises to regain their hearing as well as their ability to process speech. This takes some time and work, but it is worth it. The benefits of regaining hearing that has been lost include improved quality of life, decreased fatigue — it is exhausting to constantly try to figure out what someone is saying — decreased frustration and depression, and less social anxiety caused by the fear that others are talking about you. Lastly, the benefits from all of the above are management of blood sugar. This means decreased risks for additional complications.

Anything else you’d like to add?

Rinker: There is a very passionate group of DCES working to increase awareness about diabetes and hearing loss. I can’t begin to express the joy when we opened up the 2021 American Diabetes Association’s standards of medical care for diabetes on December 9, 2020, and found that table 4.4-Referrals for initial care management included “Audiology, if indicated.” We are finally being heard.

For more information:

Joanne Rinker, MS, RD, CDCES, LDN, FADCES, is director of practice and content development at the Association of Diabetes Care & Education Specialists. She can be reached at jorinker@gmail.com; Twitter: @joannerinker.

Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.