Diabetes affects nearly every system in the body, and the auditory system is no exception—although it’s often an overlooked aspect of diabetes care. We know that glucose stability can help improve health for the entire bodily system, and now we’re exploring the relationship between diabetes and hearing loss across all types of diabetes, including the impact on individuals and babies born to mothers with gestational diabetes (GDM). Read on to learn more about how glucose levels can affect hearing—and how utilizing tools like time in range can help.1
Why Does Diabetes Affect Hearing?
Prolonged elevated blood sugar levels damage small blood vessels throughout the body, a condition known as microangiopathy. Similar to the vessels in the eyes and kidneys, the inner ear relies on delicate blood flow. When these vessels are compromised, sound transmission and auditory processing can deteriorate. Neural degeneration further reduces the brain’s ability to interpret sound accurately, leading to gradual sensorineural hearing loss, difficulty understanding speech in noisy environments, and increased listening fatigue.
In 2021, the American Diabetes Association (ADA) added audiology to the Standards of Medical Care in Diabetes, recognizing hearing health as a critical component of comprehensive diabetes management. While this inclusion was a major step forward, it is often treated as a recommendation rather than a requirement. Audiology referrals should not be optional—they should be a standard part of care, just like eye exams, foot checks, and dental visits. Making audiology an integral part of diabetes care ensures early detection, timely intervention, and better long-term outcomes.
Type 1 and Type 2 Diabetes
Both type 1 and type 2 diabetes significantly increase the risk of hearing loss, particularly at high frequencies.2 Individuals with prolonged hyperglycemia are at heightened risk for long-term auditory complications, including tinnitus and vestibular dysfunction.3 Despite these well-documented risks, hearing screenings are rarely incorporated into standard diabetes care plans—a critical gap in comprehensive management. Untreated hearing loss can profoundly impact daily life, leading to social isolation, anxiety, and frustration. These challenges add stress, which can contribute to diabetes distress or burnout. Early intervention is essential: rehabilitation with hearing aids or assistive devices not only improves communication and quality of life but also reduces listening fatigue, which is physically and mentally exhausting. Ensuring that people with diabetes attempt to avoid further damage by introducing them to CGM and metrics like time in range can help lower A1C and optimize glucose levels.
Gestational Diabetes and Infant Hearing
As the placenta grows, hormones are produced, and the risk of insulin resistance becomes greater. Normally, the pancreas is able to make additional insulin to overcome insulin resistance, but when the production of insulin is not enough to overcome the effect of the placental hormones, gestational diabetes results.
According to the American Diabetes Association, up to 9% of pregnant women in the U.S. are diagnosed with gestational diabetes, and studies show their newborns have a two- to three-fold higher risk of hearing loss compared to those from non-GDM pregnancies.
Children born to mothers with gestational diabetes (GDM) have a higher risk of hearing loss, particularly sensorineural hearing loss. Higher glucose levels, or lower time in range, during pregnancy can damage developing nerves and blood vessels in the inner ear, leading to impaired hearing sensitivity, with some studies showing higher failure rates on newborn hearing screenings. While the risk is elevated, the hearing loss is often manageable with appropriate audiological follow-up and management.4-5
Why does GDM increase the risk of hearing loss?
Hyperbilirubinemia, a condition characterized by elevated bilirubin levels, is more common in these infants whose mothers have GDM, and is a known risk factor for hearing impairment. Additional complications associated with GDM, such as perinatal asphyxia and congenital heart disease, further contribute to this risk. Research indicates a higher prevalence of hearing loss among newborns from GDM pregnancies compared to those without. The hearing loss observed is often bilateral and sensorineural, affecting the inner ear and auditory nerve pathways, and children may be particularly prone to high-frequency hearing loss.6-7
Newborns of mothers with gestational diabetes mellitus (GDM) may have a higher likelihood of abnormal results on newborn hearing screening (NHS), making early detection critical. If an infant does not pass the initial screening, a comprehensive audiological evaluation—including assessment of high frequencies above 10 kHz—and timely follow-up are essential to confirm hearing status and manage any identified loss. Additionally, clinicians should monitor for other risk factors such as hyperbilirubinemia and perinatal asphyxia, which can further increase the risk of hearing impairment.
Using diabetes technology in pregnancy can help both healthcare professionals and the mother monitor their glucose to keep it in a tighter range shown to decrease complications. This new international consensus gives guidelines on use of CGM in pregnancy—check it out here!
What can you do?
Avoiding these complications before they happen is always the ideal scenario. The best way to monitor glucose values to avoid continued hyperglycemia is through using a CGM—which gives a glucose reading every 5 minutes. The metrics CGMs provide, like time in range, can give you a view of how long someone is staying in their target range, allowing you to pinpoint “problem” areas and work with those in your care to establish plans to help keep glucose levels in range as long as possible. Research has actually shown a direct correlation between time spent in range and risk of diabetes-related complications like retinopathy. When you know more, you can do more!
Additionally, incorporating hearing screenings into routine diabetes care at diagnosis and annually thereafter can make a big difference. Use quick tools like the HearScreen app and refer people with diabetes to audiologists if they have been newly diagnosed with diabetes, as suggested by the audiologist after the initial assessment and if they are a newborn of mothers with GDM. Educate people with diabetes about the link between diabetes and hearing health during DSMES sessions.
Remember: early detection can preserve communication, cognitive health, and quality of life. Together, we can make hearing health an essential part of diabetes management.
- Bainbridge, K. E., Hoffman, H. J., & Cowie, C. C. (2011). Diabetes and hearing impairment in the United States: Audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Annals of Internal Medicine, 154(5), 346–355. https://doi.org/10.7326/0003-4819-154-5-201103010-00006
- Horikawa, C., Kodama, S., Tanaka, S., Fujihara, K., Hirasawa, R., Yachi, Y., … & Sone, H. (2013). Diabetes and risk of hearing impairment in adults: A meta-analysis. Journal of Clinical Endocrinology & Metabolism, 98(1), 51–58. https://doi.org/10.1210/jc.2012-2119
- Gioacchini, F. M., Albera, R., Re, M., Scarpa, A., Cassandro, C., & Cassandro, E. (2018). Hyperglycemia and diabetes mellitus are related to vestibular organs dysfunction: Truth or suggestion? Acta Diabetologica, 55(12), 1201–1207. https://doi.org/10.1007/s00592-018-1183-2
- Johns Hopkins Medicine. (2025). Gestational diabetes mellitus (GDM). https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/gestational-diabetes. Accessed online 11/4/2025
- American Diabetes Association (2025). Gestational diabetes. https://diabetes.org/living-with-diabetes/pregnancy/gestational-diabetes. online 11/5/2025
- Aggarwal K, Ravi R. Effect of Gestational Diabetes Mellitus on Newborn Hearing: A Systematic Review. Ann Otol Rhinol Laryngol. 2025 Feb;134(2):87-92
- Sharma K, Mehta N, Kalita R. The Effect of Gestational Diabetes Mellitus on Hearing of Neonates in a Tertiary Healthcare Centre. Indian J Otolaryngol Head Neck Surg. 2023 Apr;75(Suppl 1):620-627.
- Lee JA, Mehta CH, Nguyen SA, Meyer TA. Hearing outcomes in children of diabetic pregnancies. Int J Pediatr Otorhinolaryngol. 2020 May;132
- Lee JA, et al. (2020). Hearing outcomes in children of diabetic pregnancies. Intl J Ped Otorhinolaryngol, 132, May