Adults with type 2 diabetes are more than twice as likely to develop clinically significant hearing loss compared to those without diabetes, according to a new review of 29 studies involving over 17,000 participants. Despite this striking finding, hearing loss remains largely overlooked in standard diabetes care, even though it affects roughly one in four people living with the condition.

Why Is Hearing Loss a Hidden Diabetes Complication?

Diabetes is well known to damage multiple systems in the body, including the eyes, kidneys, and nerves. Healthcare providers routinely screen for related complications such as diabetic retinopathy (eye damage), kidney disease, and neuropathy (nerve damage). However, hearing loss has never been systematically integrated into standard diabetes care protocols, leaving it largely undetected and unmanaged.

"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. Hearing loss has never been systematically built into those care protocols, so it's essentially fallen through the cracks," explained Mehwish Nisar, MD, PhD, AFHEA, a Postdoctoral Research Fellow and Affiliate of the University of Queensland Centre for Hearing Research.

Mehwish Nisar, MD, PhD, AFHEA, Postdoctoral Research Fellow, University of Queensland Centre for Hearing Research

The review, published in Diabetes Metabolism Research and Reviews, analyzed data from studies conducted between 2000 and 2025. Researchers found that across 23 studies involving more than 5,200 people with diabetes, approximately one in four had moderate-to-severe hearing loss. When compared to people without diabetes, those with the condition were significantly more likely to experience clinically significant hearing loss.

Who Is at Greatest Risk for Diabetes-Related Hearing Loss?

The research revealed that certain groups face higher risk than others. Adults under age 60 with diabetes were around three times more likely to have moderate-to-severe hearing loss than people of the same age without diabetes. Interestingly, the increased risk was also seen in those who had been living with diabetes for fewer than 10 years, suggesting that hearing problems may develop earlier than previously thought.

The association was also stronger in studies from low- and middle-income countries, though researchers noted that more investigation is needed to understand why this pattern exists. Based on World Health Organization estimates, these findings suggest that hundreds of millions of people globally may be living with serious hearing impairment as a complication of diabetes.

How Does Diabetes Damage Hearing?

The biological mechanism behind diabetes-related hearing loss involves damage to the delicate structures of the inner ear. Persistently high blood glucose levels can harm small blood vessels and nerves that supply the cochlea, the hearing center of the inner ear. This damage occurs through several pathways, including microangiopathy (small vessel damage), oxidative stress, and neuropathy affecting the auditory nerve pathways. Over time, this cumulative damage impairs the ear's ability to detect sound, particularly at higher frequencies.

"Chronic high blood glucose damages the small blood vessels and nerves supplying the cochlea in much the same way it damages the retina, kidneys, and peripheral nerves. 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," noted Nisar.

Mehwish Nisar, MD, PhD, AFHEA, Postdoctoral Research Fellow, University of Queensland Centre for Hearing Research

The Centers for Disease Control and Prevention (CDC) reports that hearing loss is twice as common in people with diabetes as in those without the condition. Additionally, people with prediabetes have a 30% higher rate of hearing loss compared to those without either condition.

Steps to Protect Your Hearing If You Have Diabetes

• Ask Your Care Team About Hearing Screening: Request a baseline hearing test as part of your routine diabetes care, especially if you are under age 60 or have had diabetes for fewer than 10 years. Early detection can help you access support sooner.
• Monitor for Gradual Changes: Pay attention to subtle signs of hearing loss, such as difficulty following conversations in noisy environments, needing to turn up the volume on devices, or asking others to repeat themselves more frequently.
• Control Your Blood Glucose Levels: Work with your healthcare provider to maintain healthy blood sugar levels through medication, diet, and lifestyle changes, as persistently high glucose is the primary driver of inner ear damage.
• Get Regular Audiometric Tests: Standard audiometric tests, which measure hearing across different frequencies, can detect hearing loss early before it significantly impacts daily communication.

What Should Diabetes Care Include Going Forward?

The study authors argue that routine hearing tests should be incorporated into standard diabetes care protocols, similar to how screening for retinopathy, kidney disease, and neuropathy is already established. This would help identify hearing problems earlier and allow people to access hearing aids or other interventions sooner.

"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," stressed Nisar.

Mehwish Nisar, MD, PhD, AFHEA, Postdoctoral Research Fellow, University of Queensland Centre for Hearing Research

While the review could not establish that diabetes directly causes hearing loss, it demonstrated a consistent and significant association across diverse populations and study designs. The researchers emphasized that people with diabetes should not wait until hearing loss becomes advanced or assume it is simply a normal part of aging. Instead, they should proactively discuss hearing health with their care team, particularly if they fall into higher-risk groups.

As diabetes care standards continue to evolve, incorporating routine hearing assessments could help prevent or delay this often-overlooked complication, improving quality of life for millions of people living with the condition.