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10 September 2026

51 Pages

Hearing Health Monitoring in Adults Living with Diabetes: A Scoping Review to Inform Integrated Care Pathways

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Health and Rehabilitation Sciences, Western University, London, ON N6G 1H1, Canada
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The National Centre for Audiology, Western University, London, ON N6G 1H1, Canada
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School of Communication Sciences and Disorders, Western University, London, ON N6G 1H1, Canada
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H.A. Leeper Speech and Hearing Clinic, Western University, London, ON N6G 1H1, Canada
Audiol. Res.2026, 16(5), 134;https://doi.org/10.3390/audiolres16050134
This article belongs to the Section Hearing
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Abstract

Objectives: Diabetes is a significant risk factor for hearing loss, highlighting the need for evidence-informed hearing health monitoring. Undiagnosed and untreated hearing loss can impair communication, reduce participation in daily activities, and diminish quality of life. This scoping review synthesized the current evidence on hearing loss screening and assessment in adults living with diabetes and identified knowledge gaps to inform the development of an evidence-informed hearing health monitoring framework. Design: A scoping review was conducted in accordance with the Joanna Briggs Institute methodology. Seven electronic databases were searched for peer-reviewed studies reporting primary data on the relationship between diabetes and hearing loss. Results: A total of 201 studies met the inclusion criteria. The literature represented a global evidence base, with studies conducted across diverse settings, including hospitals, community and diabetes clinics, schools, audiology clinics, outpatient clinics, and research centres. Pure-tone audiometry was the most frequently used assessment, followed by electrophysiological measures and otoacoustic emissions. Fewer than half of the studies provided recommendations for hearing screening, assessment, or monitoring, and only six advocated for early referral to hearing healthcare services. Conclusions: Despite growing evidence linking diabetes and hearing loss, important gaps remain in recommendations for diagnostic assessment, hearing health monitoring, referral pathways, and interdisciplinary integration within diabetes care. The findings of this review provide a foundation for developing an evidence-informed hearing health monitoring framework and support the integration of hearing health into coordinated person-centred diabetes care pathways.

1. Introduction

Diabetes mellitus (DM), affecting approximately 11% of Canadian adults, is a significant risk factor for the development of retinopathy, neuropathy, nephropathy, and cardiovascular diseases [1,2]. More recently, hearing loss (HL) has been recognized as a complication of DM, with established evidence demonstrating an association between DM and auditory dysfunction. While the more established complications of DM are routinely monitored as part of diabetes management, hearing loss remains underrecognized and has yet to be incorporated into standard clinical care pathways [3,4]. Evidence suggests that HL may develop at a younger age in individuals with DM and is about twice as prevalent among people living with diabetes compared to those without the condition, even after adjusting for age and other risk factors for HL [5,6,7]. A recent systematic review and meta-analysis estimated that nearly one in four adults living with DM has a moderate-to-severe hearing loss (≥40 dB HL) [8]. Despite this substantial burden, hearing health has yet to be routinely incorporated into diabetes care, highlighting an important gap between the available evidence and current clinical practice [8].
The need to monitor and manage hearing health in individuals living with DM is increasingly recognized by national and international health organizations. Diabetes Canada [9] acknowledges that individuals living with DM are at an increased risk of HL while the World Health Organization [10] continues to consistently advocate for hearing screening for this population. Recommendations have also been proposed to inform and support early detection and management of HL in individuals living with DM, using current evidence-based audiological measurement tools [7]. Comprehensive audiological awareness, monitoring protocols, and guidance for integrating hearing care into routine diabetes management remain lacking.
Undiagnosed and untreated HL in adulthood extends beyond a sensory impairment. It adversely affects communication, limits participation in daily activities, and contributes to social isolation, loneliness, and reduced quality of life [11,12]. Reduced social engagement, poorer mental well-being, and decreased physical activity can also increase the risk of cognitive decline and dementia [13]. As the Canadian population continues to increase, the prevalence of DM and its associated personal, societal, and healthcare costs are expected to increase as well [14]. These challenges underscore the need to identify effective resources, strategies, and models of care to support early identification, monitoring, and management of HL among adults with DM. The purpose of this scoping review is to gather, summarize, and synthesize the peer-reviewed literature on early detection, assessment, and monitoring of hearing loss in adults living with diabetes, as well as on primary care integration pathways to support their care. A secondary aim was to use the synthesized evidence to propose a practical framework for integrating hearing health into routine diabetes management.

2. Methods

This review was undertaken following the Joanna Briggs Institute (JBI) methodology for scoping reviews and is presented in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance and checklist [15].

2.1. Protocol

The PRISMA-ScR checklist is provided in the Supplementary Material (File S1). Ethics approval was not required for this study. Scoping reviews are exempt from research ethics review when they rely on secondary, anonymized data.

2.2. Eligibility Criteria

Studies were included using the following criteria: (a) peer reviewed sources; (b) published or accessible in English; (c) electronic full-text available; (d) primary data; (e) including adult participants aged 18 years or older; (f) DM as the primary disease of interest, not only a risk factor for another disease; (g) hearing status identified through an auditory system assessment; and (h) relationship between DM and HL. Studies published in languages other than English were excluded due to the research team’s language limitations. Grey literature was excluded based on a preliminary search indicating limited relevant guidance. The review therefore focused on primary research evidence to inform the development of future guidance.

2.3. Information Sources

Seven databases were searched: MEDLINE(R) ALL (Ovid), Cochrane Central Register of Controlled Trials, Embase and Embase Classic (Ovid), APA PsycInfo (Ovid), CINAHL (EBSCO), Scopus, and Web of Science. Databases were selected in consultation with a research librarian at Western University to maximize the comprehensiveness of the search. No limits were placed on the study context or the publication date of included studies. The search was completed in April 2026 across all seven databases.

2.4. Search Terms

A list of preliminary search terms was created by five members of the research team (CA, CM, DG, JB, PK). The search terms were refined with input from a research and scholarly communications librarian to incorporate subject headings, keywords (e.g., diabetes, hearing loss), and indexing terms such as Medical Subject Headings. Appendix A details a full set of search terms used in the Ovid MEDLINE database, which were replicated and modified for the remaining databases.

2.5. Selection of Sources of Evidence

A three-step search strategy was employed in the scoping review protocol: an initial search, modification of the search strategy, and screening processes. Step one involved an initial search limited to two online databases, conducted by one member of the research team (JB), to determine the suitability of the search terms and the availability of existing evidence on the topic. Search terms were modified to ensure that the findings were comprehensive and aligned with the objectives of the scoping review following this step. Step two identified articles through analysis of text words in the titles and abstracts, and index terms from the initial search, followed by a comprehensive search across all included databases using the refined keywords and indexed terms. All records were imported into Covidence, an online systematic review management platform, where duplicate articles were automatically removed [16]. A pilot screening was conducted following the JBI protocol (Section 10.2.6, Source of Evidence Selection), in which five team members (CA, CM, DG, JB, PK) reviewed 25 randomly selected articles to ensure consistent application of the eligibility criteria. Any disagreements over the eligibility of evidence sources for inclusion in the review were discussed and resolved in team meetings during the screening phases. All research team members independently conducted title and abstract screening using Covidence. Team meetings (CA, CM, DG, GM, JB, PK, RO) were held to achieve consensus when disagreements arose around the inclusion of specific studies. Evidence that passed the title/abstract screening phase was then moved to the full-text stage, where two members independently screened against the inclusion criteria. Evidence from the full-text stage that met the inclusion criteria was included and extracted.

2.6. Data Charting Process and Data Items

A draft data charting table to guide data extraction (Supplement File S2) was developed by the research team using Microsoft Excel (Version 16.64). All members of the research team were involved in the data extraction phase. To ensure consistency in data extraction and agreement on extraction components, four members (DG, CA, CM, JB) piloted the extraction form with two randomly selected studies. The final data charting table included components such as study design, participant details, type of audiological testing tools, healthcare professional roles, and study findings. Data extraction for each article was completed by at least two research team members. Data extraction was independently conducted within Covidence, and a third team member completed the consensus step to ensure alignment of data extracted from each article. If disagreements arose, they were discussed during regularly scheduled team meetings. Data extraction was conducted iteratively, with categories added or modified in consultation with the full research team to align with the review objectives.

3. Results

A total of 16,219 studies were identified, of which 8748 were duplicates. The title and abstract screening resulted in the removal of 6996 studies that did not meet the eligibility criteria, followed by the removal of 274 studies during full-text review. During the data extraction phase, 201 adult-focused studies were identified. The PRISMA-ScR flow diagram (Figure 1) summarizes the process for evidence inclusion as a result of this review. The final set of included articles is summarized in Appendix B according to study design, aims, participant age, healthcare providers involved in audiological care, assessment tools, and recommendations. Articles were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) for levels of evidence [17].
Figure 1. PRISMA-ScR Flow Diagram.

3.1. Global Representation and Timeline

The literature in this scoping review spanned more than six decades, from 1974 to 2026. The included studies represented a diverse international body of literature, with India contributing the largest number of publications (n = 76). By continent, most studies originated from Asia (n = 128), followed by Europe (n = 28), North America (n = 24), Africa (n = 11), South America (n = 7), and Australia (n = 3).

3.2. Diabetes Classification, Age Classification, and Duration of Diabetes

Most studies exclusively investigated T2DM (n = 103), with a small number studying only T1DM (n = 21); some studies assessed both T1DM and T2DM (n = 21). Approximately one-quarter of the studies did not specify the type of DM (n = 56). Reporting of participant age was incomplete across studies, with many failing to report either the age range or the mean age. Among studies that provided age-related information, participants were at least 18 years of age, with reported upper age limits extending to ≥70 years; however, the true upper age range across all included studies could not be determined. Reporting of participant characteristics was incomplete across the included studies. Among studies that reported these data, 131 reported the mean age of participants living with DM, 88 reported the mean or range of diabetes duration, and 20 reported the time of diabetes onset.

3.3. Healthcare Professionals and Professional Settings

Reporting of the healthcare professionals involved in the identification of HL was limited across the included studies. Of the 201 studies included in this review, only 11 specified which professional was involved in the care of the patient. Professionals included one audiologist, four physicians, one research physician, one general practitioner, one primary care practitioner, one internist, one otologist, two ophthalmologists, and one unspecified healthcare provider.
The professional settings involved in HL identification were often reported at a broad departmental level, lacking contextual detail. Hospitals were the most frequently reported location (n = 106). Additional settings included: within the research study (n = 32), school (n = 12), DM-specific setting (n = 11), community-based setting (n = 6), general healthcare centre (n = 5), audiology clinic (n = 4), and outpatient clinic (n = 2). In several studies, the setting was not reported (n = 23).

3.4. Case History and Patient-Reported Outcome Measures

Some studies collected case history information focused on demographics and medical information (n = 132); however, fewer studies employed patient-reported outcome measures or questionnaires to assess the impact of potential auditory system damage on daily functioning (n = 23). Of the questionnaires mentioned, the Michigan Neuropathy Screening Instrument was most frequently used to screen for diabetic peripheral neuropathy (n = 5) [18]. Other questionnaires focused on cognitive impairment, noise exposure, dizziness, and psychosocial impact.

3.5. Comorbidities and Risk Factors

Information on the presence of comorbidities alongside diabetes was mentioned in approximately half of the studies (n = 121). The most common comorbidities included retinopathy (n = 61), hypertension (HTN; n = 58), neuropathy (n = 50), and nephropathy (n = 26). Braffett and colleagues [19] reported that risk factors such as retinopathy, kidney disease, neuropathy, and a history of HTN, among others, were significantly associated with a higher likelihood of speech-frequency hearing loss. Studies examining comorbidities yielded heterogeneous findings: some reported significant associations with hearing outcomes, while others found none.
Some studies examined poor glycemic and metabolic control as a risk factor for HL. Esubalew and colleagues [20] reported that glycemic control was significantly associated with SNHL, defined as an inability to perceive sounds at 25 dB or lower in one or both ears. HbA1c levels, an indicator of long-term glycemic control, were often reported to be higher among individuals living with DM. Krishnappa and Naseeruddin [21], showed a positive relation between HbA1c and the severity of HL. As glycemic control deteriorated, the severity of HL increased. When glycemic control was poor, most cases presented with either moderate or moderately severe HL [21]. Additionally, hearing loss was observed across a range of frequencies, with a greater degree of loss noted among individuals living with DM compared to non-diabetic individuals, particularly at higher frequencies [21].
The duration of DM was inconsistently reported across studies, with some providing wide-ranging values such as 0.1 to 30.0 years [22], while others did not report duration. Among studies that included duration as a variable, results were mixed as to whether it was a risk factor for HL. Dosemane and colleagues [23] grouped duration of DM into <5 and >5 years (no mean was provided). They noted that the duration of DM did not statistically impact the severity of HL. J. Li and colleagues [24] indicated a possible correlation between the duration of DM, glycemic control and the incidence of high frequency HL. Specifically, when comparing groups with T2DM for <10 or ≥10 years, no significant difference in HL was observed between the two groups, but at higher frequencies, significant differences in HL were observed among patients according to both disease duration and HbA1c levels.

3.6. Hearing Assessment Tools

Although assessment tools were generally well described, the rationale for selecting specific measures was often not reported. Nearly all studies incorporated pure-tone audiometry (PTA), encompassing both standard and extended high frequency assessments. Studies evaluated hearing across low-mid (250–2000 Hz; n = 141), mid-high (3000–4000 Hz; n = 140), high (6000–8000 Hz; n = 125), and extended high frequencies (≥10,000 Hz; n = 23), with some reporting significantly elevated thresholds in individuals with DM compared to healthy controls (Figure 2). Data were also extracted on whether air conduction and/or bone conduction testing was performed, and on the reported type of hearing loss. Among studies reporting hearing loss type, 99 reported sensorineural hearing loss only, eight reported sensorineural or conductive hearing loss, and 12 reported sensorineural, conductive, or mixed hearing loss. No studies reported conductive hearing loss as the sole type of hearing loss.
Figure 2. Pure Tone Audiometry Findings.
Multiple forms of OAEs and electrophysiological tools were used as diagnostic measures. Types of OAEs included distortion product otoacoustic emissions (DPOAEs; n = 32), transient evoked otoacoustic emissions (TEOAEs; n = 14), evoked OAEs with the specific type not further specified (n = 16), and a single study used stimulus frequency OAEs. Thirteen studies reported reduced OAE amplitude in the group living with DM. In addition, ten of the studies reported absent OAEs in the group living with DM. When considering the electrophysiological measures, most studies included auditory brainstem measures (n = 41), with very few including cortical testing (n = 2), auditory steady-state response (n = 2), or electrocochleography (n = 1). Over half of the studies using auditory brainstem responses (ABRs) reported prolonged absolute and/or interwave latencies (n = 22). For cortical testing, all studies reported prolonged wave latencies in the group living with DM, and one study reported reduced wave amplitudes in the group living with DM when compared to the control group. Table 1 presents the results from the studies, specific to the different types of OAE and electrophysiological diagnostic measures. Otoscopy (n = 32), tympanometry (n = 53), acoustic reflex testing (n = 29), speech audiometry (n = 35), the tuning fork (n = 17), and speech-in-noise (SIN) measures (n = 4) were also incorporated as an adjunct to standard audiological evaluation or to support inclusion eligibility criteria.
Table 1. Otoacoustic Emissions (OAEs) and Electrophysiology Measurements.
Results related to SIN testing included a study by Abou-Elew and colleagues [33] that reported a statistically significant difference between individuals with DM and control groups, with individuals living with DM demonstrating poorer performance on the SIN test. Using the QuickSIN, Konrad-Martin and colleagues [34] found that individuals with uncontrolled DM demonstrated poorer SIN performance than the control group, although these differences did not reach statistical significance [35]. Similarly, Falahzadeh and colleagues [36], found that individuals living with DM demonstrated significantly poorer overall SNR-50 thresholds, the signal-to-noise ratio where a person understands 50% of speech, at difficult noise conditions (15, 10, 5, 0 SNR). Iqbal and colleagues [37] found no significant differences in SNR-50 thresholds between individuals living with diabetes for 5–10 years and those with >10 years of disease duration. Correlation analysis indicated a moderately strong association, suggesting that living with DM for a longer duration is associated with greater difficulty listening to speech in noisy conditions [37].

3.7. Reported Clinical Recommendations

A larger proportion of studies did not report recommendations (n = 118) compared with those that did (n = 83). Some recommendations included screening (n = 59), hearing check-ups (n = 28), follow-up hearing assessments (n = 12), preventative care (n = 14), risk reduction (n = 11), early referral (n = 6), collaborative healthcare efforts (n = 10), early intervention (n = 6), and metabolic assessments (n = 2). When recommendations were noted, they varied considerably and were vague. Agrawal and colleagues [38] recommend that patients living with DM undergo periodic audiometric evaluations alongside regular blood glucose monitoring to prevent severe hearing loss, although no specific timeframe for monitoring was provided.
Recommendations regarding assessment approaches also varied across studies. PTA was frequently recommended for screening, likely due to its relatively low cost and widespread availability across referral units and tertiary care centres [39]. In some studies, high frequency PTA was recommended as an essential tool to identify early onset of HL [40,41,42,43,44,45]. Recommendations regarding the timing of PTA varied across studies. Adebola and colleagues [46] suggest PTA assessment at the time of T2DM diagnosis and then at a minimum of six-monthly intervals depending on initial results, while Mishra and Poorey [47] propose annual screening with PTA. One study noted that PTA may not be appropriate for detecting underlying hearing dysfunction in T1DM [48].
Regarding ABR recommendations, one study recommended testing individuals living with DM using ABR once per year, as ABR recordings at higher frequencies, such as 6 kHz and at 80 dB, may facilitate earlier detection of central neuropathy [49]. Three studies also recommend the use of DPOAE for early detection of subclinical auditory dysfunction and as a useful tool to identify individuals who may benefit from regular audiologic monitoring and improved glycemic management [50,51,52].

4. Discussion

This scoping review synthesized evidence from 201 peer-reviewed studies examining the association between DM and HL, with a particular focus on approaches to hearing health assessment, monitoring, and management. Although the evidence consistently supports an association between DM and HL, the review identified substantial gaps in clinical practice guidance, including the absence of standardized hearing-monitoring recommendations, inconsistent reporting of referral pathways, and limited integration of audiologists into diabetes care teams. At the same time, the findings provide important direction for future care pathways. The included studies demonstrate that audiological assessments, including behavioural threshold testing, OAEs, and ABRs, each provide complementary information by evaluating hearing sensitivity, cochlear function, and neural auditory function, respectively, and may support the early identification and/or monitoring of diabetes-related auditory changes. The findings also suggest that hearing monitoring strategies could be strengthened by incorporating patient-specific risk factors, such as glycemic control, alongside patient-reported hearing measures to identify individuals who may benefit from earlier or more frequent audiological assessment. Collectively, these findings underscore the need for evidence-informed hearing monitoring recommendations and greater interdisciplinary integration of hearing healthcare into routine diabetes management.

4.1. Inconsistent Assessment, Monitoring and Management Strategies

Assessment measures varied significantly across studies, with considerable differences in testing protocols, assessment batteries, and frequency ranges evaluated, limiting comparability across the literature. Recommendations for assessment tools differed across studies, ranging from conventional threshold testing to ABR and OAE testing. As highlighted in the literature, objective measures such as OAEs are well-suited as simple, rapid screening tools [53], while complementary assessments such as PTA provide the audiological information necessary to guide clinical management [54]. Particularly, high and extended high frequency testing is needed, given that high frequency HL is most often observed in individuals living with DM [55]. Similar variability was observed in recommendations for hearing monitoring. While some studies recommended regular auditory assessments, others recommended monitoring at specific intervals, such as annually [47,56]. This variability highlights the need for evidence-based guidance to establish standardized assessment protocols and monitoring schedules for adults living with DM. Future clinical guidelines should balance measurement specificity with clinical feasibility. Although specialized assessments such as high frequency ABR may detect early auditory changes, routine implementation may be constrained by equipment availability, clinician expertise, appointment duration, and healthcare resources. Recommendations should distinguish between essential components that are feasible in routine practice and optional or specialized assessments that can be incorporated when resources permit or clinical indications warrant.

4.2. Subclinical Auditory Dysfunction and Early Detection

Progressive HL often occurs in adults living with DM, with early subclinical changes that can occur before HL becomes detectable using standard audiometric testing. Some of the included studies reported normal hearing thresholds within conventional frequency ranges, despite evidence of auditory dysfunction, including elevated extended high frequency thresholds, reduced OAE amplitudes, or prolonged electrophysiological wave latencies. These findings may suggest that standard behavioural audiometry alone may be insufficient to identify early cochlear and neural changes associated with DM. K.D. Joshi and colleagues [57] noted that although PTA can detect HL, it is limited in its ability to identify early-stage auditory changes and support timely intervention. PTA is less sensitive when it comes to detecting subtle auditory changes due to DM. This limitation may reduce its utility as a standalone screening tool for detecting subtle changes in the auditory system [57]. While incorporating a range of audiological measures may improve early identification and support timely monitoring and intervention, such approaches may not be accessible in all clinical contexts.

4.3. Functional Hearing Assessment

In resource-limited settings, initial screening may be conducted with patient-reported outcome measures such as the Hearing Handicap Inventory for the Elderly–Screening Version or a single-question screening approach, with referral for comprehensive audiological evaluation for individuals who report hearing difficulties [58,59]. Four included studies incorporated SIN testing as part of the audiometric assessment battery. Functional hearing extends beyond the measurement of hearing thresholds and reflects an individual’s ability to communicate effectively in everyday listening environments. Assessments may include speech recognition in quiet and noise, patient-reported measures of hearing and communication, ecological or real-world listening assessments, and other measures of auditory function. SIN testing was the only objective functional hearing measure identified in the current literature. Although evidence remains limited, it may be important to incorporate functional hearing assessments alongside conventional audiometric testing to improve the early identification and monitoring of diabetes-related auditory changes and to capture deficits that are not apparent based on PTA alone.

4.4. Multi-Level Auditory Involvement in Adult DM

The findings of this review suggest that DM is associated with auditory dysfunction across multiple levels of the auditory system, including cochlear, neural, and functional components. Behavioural assessments such as PTA commonly identify elevated hearing thresholds, most notably at higher frequencies, with poorer hearing outcomes associated with longer disease duration and poorer glycaemic control. Only three studies showed reduced OAEs when both the group living with diabetes and the control group had normal PTA thresholds [60,61,62]. No studies showed a delayed absolute wave V latency when both the group living with diabetes and the control group had normal PTA thresholds. Objective cochlear measures using OAEs indicated early outer hair cell dysfunction, despite normal audiometric thresholds, suggesting subclinical auditory changes. Electrophysiological measures, particularly ABRs, frequently demonstrated delayed wave latencies consistent with slowed neural transmission along the auditory pathway. Although associations between hearing outcomes and clinical factors, such as glycemic control and duration of DM, were not consistently reported across studies, the overall pattern of findings supports a progressive trajectory of hearing loss in people living with DM, characterized by subtle subclinical changes and potential auditory dysfunction at both the cochlear and neural levels.

4.5. Age as a Confounding Variable

As individuals age, the prevalence of HL increases, with more than 65% of adults aged 60 years and older experiencing HL [63]. The present scoping review identified 63 studies that included participants living with diabetes older than 60 years of age. Given the high prevalence of age-related HL among older adults, age may represent an important confounding factor when examining the association between DM and HL. Among the included studies involving adults over 60 years of age, only 12 explicitly identified age-related HL as a potential confounder [31,55,57,64,65,66,67,68,69,70,71,72]. Mitchell and colleagues [68] examined the relationship between T2DM and the prevalence, incidence, and progression of age-related HL. Their findings suggest that T2DM may not predispose older individuals to develop age-related HL but may instead exert an additive or interactive effect that contributes to a greater decline in hearing function compared to aging alone. These findings should be interpreted cautiously given the small number of participants living with DM at follow-up in this specific study [68]. More recently, Nisar and colleagues [8] reported that the risk of HL in individuals living with DM was significantly elevated among younger adults, but not among older adults. The lack of significant findings in older adults may reflect the influence of age-related HL masking the effects of diabetes, insufficient age matching between comparison groups, or limited sample size. In contrast, the strong association observed among younger adults, suggests that DM may be a more prominent independent risk factor for HL earlier in adulthood and challenges the assumption that DM-related HL is solely an acceleration of age-related HL.
Collectively, these findings highlight the importance of considering age when interpreting the relationship between DM and HL. Future research should carefully consider age as a critical factor in study design (e.g., younger versus older adults), analysis, and interpretation of findings to better clarify the independent contribution of DM to hearing outcomes.

4.6. Lack of Interdisciplinary Collaboration

DM care is complex, given its effects on multiple body systems, and requires a coordinated interdisciplinary approach and comprehensive management. Although a range of healthcare professionals involved in HL identification were identified across studies, only a subset of studies specified their roles, and these descriptions were often limited. This lack of reporting makes it difficult to determine how hearing care is coordinated for adults living with DM, or whether auditory monitoring is consistently integrated into routine diabetes care. Across the wider literature, studies indicated that awareness of DM-related auditory complications among healthcare professionals remains limited, and referral processes for hearing assessment are often poorly defined or inconsistently applied [73,74]. This may contribute to audiology involvement in DM care occurring primarily after individuals report significant hearing concerns, rather than through routine hearing health monitoring.
Some of the included studies emphasized interdisciplinary collaboration and recommended greater integration among audiologists, endocrinologists, otolaryngologists, primary care physicians, nurses, DM specialists, and health promoters [72,75,76,77,78,79]. Interdisciplinary care models can help to facilitate earlier identification of HL by increasing referrals to audiology services and incorporating hearing screening into routine diabetes management [40,72,76]. Regular hearing evaluations within diabetes care pathways may support earlier detection and management of SNHL, improving overall patient well-being [80]. Mohammed and colleagues [80] suggest that early identification of hearing loss combined with optimal management and treatment of blood glucose and blood pressure may protect against cochlear damage, highlighting the importance of coordinated interdisciplinary care. Public health initiatives also have an important role in raising awareness and providing education regarding the risk of SNHL in individuals with DM and HTN [80]. More broadly, interprofessional care models have been associated with improved clinical outcomes, including reduced complications and enhanced quality of life [81]. Integrating audiology services into established interprofessional care models supported by well-defined clinical pathways and evidence-based guidelines, as part of future research and clinical scenarios, may help promote the comprehensive and patient-centred management of adults living with DM.

4.7. Hearing Health as a Shared Responsibility Across Parallel Care Pathways

Building from this scoping review, there is an opportunity to broaden the conceptualization of hearing health within diabetes care, viewing it as both a potential complication of diabetes requiring monitoring and a factor that may influence diabetes management. Hearing difficulties can affect communication with healthcare providers, access to health information, participation in self-management, and engagement in person-centred care [82]. This review also highlights that diabetes-related metabolic and vascular changes may contribute to progressive auditory dysfunction. These reciprocal relationships support the development of parallel, shared person-centred care pathways, in which diabetes care and hearing healthcare function as complementary components of chronic disease management rather than isolated disciplines connected only through referral. Within this model, hearing health becomes a shared responsibility across healthcare providers. Diabetes care teams are well-positioned to raise awareness of the relationship between diabetes and hearing health, identify individuals at increased risk of hearing difficulties, incorporate hearing health discussions into routine care, and facilitate timely referral to audiology. Audiologists, in turn, are well-positioned to contribute expertise in hearing screening, comprehensive assessment, diagnosis, hearing aid fitting, rehabilitation, and, in many jurisdictions, the management of uncomplicated ear conditions [63]. Beyond direct patient care, audiologists also contribute to health promotion, education, advocacy, research, and interdisciplinary care, and are well-suited to identify individuals with unmet chronic disease needs through their work with patients with multiple comorbidities across diverse healthcare and community settings [83].
Few included studies provided explicit recommendations regarding hearing assessment or monitoring in diabetes, and the available evidence did not establish standardized testing protocols, monitoring intervals, or referral criteria. Accordingly, the framework proposed below should not be interpreted as an evidence-based clinical guideline. Rather, it represents a synthesis of considerations arising from the available literature and identifies areas for future research, consensus development, and clinical guidance. A stepped hearing healthcare pathway embedded within these parallel care pathways has been proposed and may provide a practical framework for integrating hearing health into routine diabetes management (Figure 3). The pathway would begin with hearing health education for all individuals living with diabetes to increase awareness of the relationship between diabetes and hearing health, encourage self-monitoring, and promote discussion of hearing concerns during routine diabetes encounters. Individuals with established risk factors, such as longer disease duration, suboptimal glycemic control, increasing age, or self-reported communication difficulties, could then undergo targeted hearing health monitoring using standardized case-history questions, patient-reported outcome measures (e.g., subjective and objective measures of hearing function), and feasible hearing screening procedures (e.g., OAEs). Those with identified hearing concerns or abnormal screening findings would be referred for comprehensive audiological assessment and individualized management, with ongoing bidirectional communication between audiologists and diabetes care providers to support coordinated, longitudinal, person-centred care.
Figure 3. Parallel, Shared Person-Centred Care Pathways in Hearing Loss and Diabetes Management.
Although the optimal monitoring intervals, referral criteria, and assessment protocols remain to be established, future clinical guidelines should balance scientific evidence with clinical feasibility. Standardized care pathways incorporating evidence-informed risk stratification, monitoring schedules, referral thresholds, and assessment recommendations could promote more consistent and proactive hearing healthcare. In diabetes management, stepped care pathways will be needed to distinguish between core monitoring components that are feasible across most practice settings and enhanced assessments that may be reserved for higher-risk individuals or implemented when resources permit. This stepped approach has the potential to improve implementation while maintaining opportunities for more comprehensive evaluation when clinically indicated. Importantly, hearing loss is not only a potential complication of diabetes but may also influence chronic disease management by reducing the quality of patient-provider communication, thereby limiting opportunities for education, shared decision-making, and the timely identification of other health concerns [82,83]. Integrating hearing health within routine diabetes care may therefore facilitate earlier identification of hearing loss, improve access to appropriate interventions, support communication and participation, and ultimately enhance quality of life for individuals living with diabetes [8]. Future research should aim to establish and evaluate person-centred hearing healthcare pathways across diverse diabetes care settings.

5. Limitations and Future Directions

Several limitations should be considered when integrating the findings of this review. The search was restricted to English-language, peer-reviewed publications, potentially excluding relevant studies. Most of the included studies employed cross sectional or case–control designs, with only six longitudinal follow-up studies identified. This limits the ability to understand the progression of HL over time and the long-term impact of DM on hearing health across the lifespan. The lack of randomized controlled trials limits the strength of conclusions about the effectiveness of interventions to prevent or manage HL in adults with DM. Future research should prioritize longitudinal and experimental study designs and improve consistency in reporting key clinical factors, such as age at DM onset and diabetes duration, to strengthen the evidence base and guide effective management strategies. The reporting of care pathways and health professional involvement was inconsistent across studies, limiting understanding of how HL identification and management are currently coordinated within DM care. More comprehensive reporting of healthcare provider roles and interdisciplinary collaboration is required to facilitate the integration of audiology into DM care. Finally, none of the included studies addressed the role of caregivers in supporting adults living with DM and HL. Although caregivers may play an important role in supporting diabetes self-management and hearing healthcare outcomes, caregiver needs and supports remain underexplored [84]. Future research should consider caregiver involvement, including education and family counselling strategies, as part of a comprehensive management approach for this population.

6. Conclusions

This scoping review synthesizes the existing evidence on the early detection, assessment, and monitoring of hearing loss among adults living with DM, with consideration of the role of care pathways in supporting the identification and management processes. The findings suggest inconsistencies in recommended diagnostic methods, limited description or reporting of referral pathways to audiology services, and a lack of attention to interdisciplinary collaboration within integrated models of care. Furthermore, the observed variability in how hearing assessments are incorporated into standard DM management underscores the lack of standardized protocols for identifying and addressing auditory complications in this population. Establishing structured, evidence-based guidelines for hearing screening and monitoring among adults living with DM may support earlier identification of auditory changes and facilitate timely intervention leading to improved communication, greater social participation and overall well-being. Similarly, clearer articulation of referral pathways and defined roles for healthcare providers may strengthen coordination across disciplines and support more integrated models of care. Greater integration of audiology services within interdisciplinary DM care teams also presents an important opportunity to enhance the continuity and comprehensiveness of care. Incorporating routine hearing assessments into established DM management pathways, supported by increased clinician awareness and engagement with family and caregivers, may promote more proactive identification and management of hearing health.
Future research should prioritize the development and evaluation of implementation strategies, including longitudinal and intervention-based study designs, to inform effective evidence-based models for integrating hearing health into DM care. Collectively, the findings of this review support a shift toward earlier, more comprehensive, and collaboratively delivered models of hearing health monitoring and management for adults living with DM. This shift will require moving beyond reactive approaches that address hearing concerns only after they emerge, toward proactive identification of HL, standardized monitoring pathways, and greater integration of audiology within interdisciplinary diabetes management.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/audiolres16050134/s1, File S1: Data Charting Tool, File S2: Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.

Author Contributions

Following the Contributor Role Taxonomy (CRediT), Authorship Contributions were Collated to Provide Visibility and Recognition for all Team Members for Each of the Following Contributor Roles, Initials are Provided to Indicate Authors that have Contributed to that Component [85]: Conceptualization (C.A., C.M., D.G. and G.M.), Data Curation (C.A., C.M., D.G., G.M. and R.O.), Formal Analysis (C.A., C.M., D.G., G.M., J.N.B., P.K. and R.O.), Funding Acquisition (C.A., C.M. and D.G.), Investigation (D.G., C.A., C.M., G.M., J.N.B., P.K. and R.O.), Methodology (C.A., C.M., D.G., G.M., J.N.B. and P.K.), Project Administration (D.G.), Resources (C.A., C.M. and D.G.), Supervision (C.A., C.M. and D.G.), Validation (C.A., C.M., D.G., G.M., J.N.B., P.K. and R.O.), Visualization (D.G., G.M. and R.O.), Writing of Original Draft (G.M.), and Revision and Editing (C.A., C.M., D.G., G.M. and R.O.). All authors have read and agreed to the published version of the manuscript.

Funding

The authors acknowledge receipt of the following financial support for the research, authorship, and/or publication of this article: This work was in part supported by the Canadian Academy of Audiology Clinical-Research Grant 2024, held by Meston, Allan, and Glista. The funding organization had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, or in the decision to submit the article for publication, nor in the preparation, review, or approval of the article.

Institutional Review Board Statement

This Scoping Review Project was exempt from review by the Health Sciences Research Ethics Board at Western University under Tri-Council Policy Statement 2.

Data Availability Statement

No new data were created or analyzed in this study.

Acknowledgments

The authors would like to thank Western University Libraries for supporting this review.

Conflicts of Interest

The authors declare no conflicts of interest.

Abbreviations

ABRAuditory brainstem response
BMIBody mass index
CAEPCortical auditory evoked potentials
DMDiabetes mellitus
DPOAEDistortion product otoacoustic emissions
EOAEEvoked otoacoustic emission
HbA1cHemoglobin A1c
HLHearing loss
HTNHypertension
IDDMInsulin-dependent diabetes mellitus
JBIJoanna Briggs Institute
NIDDMNon-insulin-dependent diabetes mellitus
OAEOtoacoustic emission
PRISMA-ScRPreferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews
PTAPure-tone audiometry
SFOAEStimulus frequency otoacoustic emissions
SINSpeech-in-noise
SNHLSensorineural hearing loss
SNRSignal-to-noise ratio
SNR-50Signal-to-noise ratio-50
SPOAESpontaneous evoked otoacoustic emissions
SSNHLSudden sensorineural hearing loss
T1DMType 1 diabetes mellitus
T2DMType 2 diabetes mellitus
TEOAETransient evoked otoacoustic emissions
WHOWorld Health Organization

Appendix A. Search Strategy

Ovid MEDLINE Search Strategy hearing disorder*.ti,ab.
  • diabet*.ti,ab. deaf*.ti,ab.
  • hearing loss.ti,ab. auditory impair*.ti,ab.
  • hearing impair*.ti,ab. hearing defic*.ti,ab.
  • hearing disab*.ti,ab. hearing difficult*.ti,ab.
  • partial deaf*.ti,ab. hearing decline*.ti,ab.
  • hearing reduc*.ti,ab. loss of hearing.ti,ab.
  • hearing challenge*.ti,ab. hearing dysfunction*.ti,ab.
  • auditory loss.ti,ab.
  • normal hearing.ti,ab.
  • functional hearing.ti,ab.
  • typical hearing.ti,ab.
  • 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19
  • 1 and 20

Appendix B

Table A1. Summary of Study Characteristics, Assessment Methods, and Clinical Recommendations.

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