Millions of Americans living with type 2 diabetes may have a serious, undiagnosed complication that no one has tested them for: significant hearing loss.
A major review published July 8, 2026 in the journal Diabetes/Metabolism Research and Reviews found that approximately one in four adults with type 2 diabetes is living with moderate-to-severe hearing impairment, and that people with diabetes are more than twice as likely to develop clinically significant hearing loss compared to people without the condition.
Researchers are now calling for hearing tests to be made a routine part of standard diabetes care, alongside the eye exams and kidney screenings that are already considered essential.
Why This Matters
Diabetes is already understood to damage the eyes, kidneys, and nerves. Clinicians monitor for these complications routinely. But hearing loss has not been included in standard diabetes care protocols — and this review suggests that gap may be leaving a substantial number of patients without diagnosis or support.
The CDC estimates that 38 million Americans have diabetes. If one in four adults with type 2 diabetes has significant hearing impairment, that represents millions of people who may be struggling with communication, social isolation, and reduced quality of life — without connecting those difficulties to their underlying condition.
For adults under 60 with type 2 diabetes, the risk was even higher. That group was approximately three times more likely to have moderate-to-severe hearing loss compared to peers of the same age without diabetes. This suggests the hearing damage may begin earlier than previously assumed, and earlier than age-related hearing loss would typically be expected.
What We Know So Far
The study was a systematic review and meta-analysis conducted by researchers including lead author Dr. Mehwish Nisar, a Postdoctoral Research Fellow affiliated with the University of Queensland Centre for Hearing Research (CHEAR).
The team analyzed data from 29 observational studies published between 2000 and 2025, covering more than 17,000 adults. The majority had type 2 diabetes or prediabetes. All studies used standard audiometric tests to assess hearing.
Key findings from the published meta-analysis include:
- Among 23 studies covering more than 5,200 people with diabetes, approximately 1 in 4 had moderate-to-severe hearing loss.
- Across 11 studies that included comparison groups without diabetes, people with diabetes were more than twice as likely to have clinically significant hearing loss (odds ratio = 2.41).
- Adults under age 60 with diabetes were approximately three times more likely to have significant hearing loss than peers without diabetes (OR = 3.03).
- Elevated risk was present even among those who had lived with diabetes for fewer than 10 years.
- The association was stronger in studies from low- and middle-income countries, though the reasons require further research.
The biological pathway is increasingly understood. The CDC notes that hearing loss is twice as common in people with diabetes as in those without it — likely because persistently elevated blood glucose damages the small blood vessels and nerve structures of the inner ear, in the same way it damages the retina and kidneys.
Where the Risk Is Highest
Because the review pooled data from studies worldwide, it cannot identify specific U.S. counties or cities with the highest burden. However, the risk profile points clearly to specific populations.
Adults with diabetes who are most likely to have significant, undiagnosed hearing loss include:
- Adults under age 60 who may attribute hearing changes to other causes or not notice them at all
- People who have had diabetes for fewer than 10 years — suggesting early-onset hearing effects
- Patients without access to audiological services, including uninsured patients and those in rural areas with limited specialty care
- Adults in communities with higher rates of poorly controlled blood glucose
According to CDC diabetes surveillance data, diabetes prevalence in the United States is highest in the Southeast, as well as in urban areas with large low-income populations. Hearing care access is more limited in rural regions and for patients without insurance or with high-deductible plans.
What Doctors and Experts Say
Dr. Mehwish Nisar, the study's lead author, told Medical News Today that hearing loss has "essentially fallen through the cracks" of diabetes care — not because the biological link is unproven, but because it has never been built into standard screening protocols the way vision and kidney monitoring have been.
Nisar emphasized that the cochlea — the hearing organ of the inner ear — is vulnerable to the same microvascular damage that affects the retina and kidneys in diabetes. "Chronic high blood glucose damages the small blood vessels and nerves supplying the cochlea," she explained, "including microangiopathy, oxidative stress, and neuropathy affecting the auditory nerve pathways."
She noted that hearing loss typically progresses silently. "People often don't notice gradual hearing decline until it starts affecting daily communication," she said.
Nisar pointed to early warning signs that patients with diabetes should watch for: difficulty following conversations in noisy environments, frequently asking others to repeat themselves, turning up the volume on devices, and feeling unusually fatigued after conversations due to the cognitive effort of listening.
"If someone with diabetes notices any of these changes," Nisar told Medical News Today, "they should ask for a pure-tone audiometric hearing test — it's simple, low-cost, and can catch clinically meaningful hearing loss before it becomes disabling."
What the Evidence Shows and What It Does Not
MedicalDaily Evidence Check
- Study type: Systematic review and meta-analysis of 29 observational studies
- Participants: More than 17,000 adults with type 2 diabetes or prediabetes
- Published in: Diabetes/Metabolism Research and Reviews , July 2026 ( DOI: 10.1002/dmrr.70195 )
- What it found: Adults with diabetes are more than twice as likely to have clinically significant hearing loss; approximately 1 in 4 already has it
- What it did not prove: The study cannot confirm that diabetes causes hearing loss — it establishes an association, not causation; confounding factors such as age, cardiovascular disease, noise exposure, and medications were not fully controlled across all 29 studies
- What readers should know: Hearing loss may develop earlier in the course of diabetes than previously recognized; a simple hearing test could identify it
Current Standards of Care in Diabetes— published annually by the American Diabetes Association — do not yet include routine audiometric screening. The study authors are calling for that to change.
Who Faces the Greatest Risk?
According to this review, the groups facing the highest risk of diabetes-related hearing loss include:
- Adults under 60 with type 2 diabetes or prediabetes
- People with longer duration of diabetes (10 or more years)
- Individuals with poorly controlled blood glucose (higher HbA1c levels)
- Adults in low- and middle-income settings with limited access to audiological services
- People who also have other microvascular complications, such as retinopathy or neuropathy
Those who are at standard risk should still discuss hearing health with their care team, particularly if they have noticed any changes in their ability to follow conversations.
Symptoms and Warning Signs to Watch For
Diabetes-related hearing loss tends to develop gradually and may not be noticed until it has progressed significantly. Patients with type 2 diabetes should watch for:
- Difficulty following conversations in crowded or noisy places
- Frequently needing people to repeat themselves
- Turning up the television or phone volume more than usual
- Misunderstanding words during phone conversations
- Feeling mentally drained after social interactions due to effortful listening
- Noticing that higher-pitched sounds — voices, alarms, birds — seem harder to detect
These signs can also reflect normal age-related hearing changes, which is why evaluation by a licensed audiologist with a standard audiometric test is important for accurate diagnosis.
What You Can Do Now
- Ask your diabetes care team about a hearing test at your next appointment — particularly if you have had diabetes for several years or have noticed any difficulty with hearing.
- Do not assume hearing changes are simply aging. Diabetes-related hearing damage can begin before age 60.
- Maintain blood glucose control. While the review could not establish causation, other research has linked better glycemic management to reduced microvascular damage throughout the body.
- Contact a licensed audiologist if you want a formal hearing evaluation outside of a diabetes visit. A standard pure-tone audiometry test is brief and painless.
- Inform your primary care physician if you notice any changes in hearing — even subtle ones — so they can be documented and monitored over time.
Cost and Access: What Patients Should Know
A standard audiometric hearing test can cost between $0 and $250 depending on insurance coverage and the facility. Medicare Part B covers diagnostic hearing tests ordered by a physician if there is a specific medical reason, though it does not currently cover routine hearing screenings. Medicaid coverage for audiological services varies by state.
Community health centers and audiology clinics at university medical programs may offer reduced-cost or sliding-scale hearing evaluations. Patients without coverage can also contact HLAA (Hearing Loss Association of America) for guidance on locating affordable services.
Hearing aids, if needed, are not covered by traditional Medicare — an ongoing policy gap that advocacy groups have raised as a barrier to care for older adults with chronic conditions, including diabetes.
What Happens Next
The study's authors are calling for the American Diabetes Association's Standards of Care to be updated to include routine audiometric screening for people with type 2 diabetes. Whether those guidelines will be revised to reflect these findings will depend on further prospective studies and clinical consensus.
Dr. Nisar stated that future research should particularly focus on younger adults with diabetes and on patients in lower-income settings where the association with hearing loss appears strongest and access to audiological care is most limited.
MedicalDaily will follow any updates to clinical diabetes care guidelines as they develop.
The Bottom Line
A rigorous review of nearly 30 studies and more than 17,000 patients has confirmed what prior research suggested: hearing loss is a common, significant, and routinely overlooked complication of type 2 diabetes. One in four patients may already be affected, and those under 60 face the greatest relative risk.
The practical takeaway is straightforward. If you or someone you care for has type 2 diabetes, ask for a hearing evaluation at the next clinical visit. Current screening protocols do not include it, but the evidence suggests they should.
