Diabetes and hearing loss: the overlooked link, early signs and when to get tested
If you live with diabetes, you already think in systems. Blood sugar affects nerves, blood vessels, kidneys, eyes, feet, heart. Hearing loss is rarely mentioned, yet the inner ear is one of the most metabolically active, microvascular-dependent organs in the body.
There’s a solid evidence base showing an association between diabetes and hearing loss. Often it’s slow, subtle, and easy to miss until conversations start to feel like hard work.
This matters in the UK because routine diabetes care focuses on the “9 key care processes” and hearing is not one of them. In other words, you might be doing everything right and still never be prompted to check your hearing unless you ask.
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Does diabetes cause hearing loss? What the evidence actually says
You may see headlines that say diabetes “causes” hearing loss. Clinically, it’s more accurate to say this: diabetes is associated with a higher risk of hearing impairment, particularly sensorineural hearing loss (inner ear), and the risk appears to increase with longer duration of diabetes and with other vascular risk factors.
A widely cited meta-analysis of observational studies found that adults with diabetes had around twice the odds of hearing impairment compared with adults without diabetes (pooled odds ratio 2.15).
More recent systematic reviews focused on type 2 diabetes report similar patterns, with hearing differences often more noticeable at higher frequencies and in people with longer diabetes duration. Findings vary because studies define “hearing loss” differently and include different age groups, but the direction of travel is consistent.
Type 1 diabetes is part of the conversation too. A 2024 systematic review concluded that there is a correlation between type 1 diabetes and auditory impairment, reinforcing the idea that this is not purely a “type 2 and ageing” issue.
The practical takeaway: if you have diabetes, hearing belongs on your “quiet complications” list, alongside eyes and feet.
What diabetes-related hearing change looks like day to day
Most people don’t notice hearing loss early on, because the brain is excellent at filling in gaps, until it can’t.
Early signs tend to be about clarity rather than volume:
• You hear people talking, but struggle to catch the words, especially in restaurants or family gatherings
• You rely more on seeing faces and lip movements to keep up
• You feel drained after socialising because listening takes effort
• You start to avoid group conversations because it’s easier than guessing
• People tell you the TV is loud, but it still doesn’t sound “clear”
A simple way to self-check: if quiet one-to-one conversation is fine, but anything with background noise feels like a blur, book a hearing test. That pattern is common in early sensorineural loss.
You may also notice tinnitus (ringing, buzzing, hissing). Tinnitus has many causes, and most often sits alongside hearing change. There is emerging evidence suggesting diabetes is associated with a small increase in tinnitus likelihood, although the effect is modest and not the main reason to act.
Why diabetes may affect hearing
Diabetes is best understood as a condition that, over time, can damage blood vessels and nerves. That’s the core mechanism behind many complications.
The inner ear is vulnerable for the same reasons:
The cochlea (the hearing organ) needs a stable blood supply. Anything that reduces microcirculation can stress delicate structures that keep hearing sharp.
Hearing is not just ears. It’s ears plus nerves plus brain processing. Diabetes-related nerve damage elsewhere in the body is well recognised, and similar processes may contribute to changes in auditory pathways.
The inner ear constantly maintains a precise electrolyte balance to convert sound into electrical signals. That’s energy-intensive work, which is why it can be sensitive to chronic metabolic stress.
A detail that helps make sense of the kidney connection (without getting too technical): some of the same families of ion channels and transporters involved in kidney function are also expressed in the inner ear, including systems involved in potassium cycling that support the cochlea’s electrical environment. This shared biology is one reason “oto-renal” syndromes exist (conditions that affect ear and kidney together).
The comorbidity stack: when risks add up
In real life, diabetes often travels with other conditions. And hearing risk is rarely about one factor in isolation.
Think in terms of stacking effects: if you have diabetes plus one or more of the following, it’s sensible to move hearing checks up the priority list.
Diabetes can damage blood vessels, and high blood pressure accelerates vascular wear and tear. The cochlea depends on healthy circulation, so vascular risk management is also hearing risk management.
Kidney disease is often a marker of microvascular burden in diabetes. There is also a strong biological “proof point” that ear and kidney pathways can overlap: for example, Alport syndrome affects kidneys and can involve hearing loss because type IV collagen is important in both organs.
If you already have diabetes-related nerve, kidney, or eye changes, that’s a
. It does not guarantee hearing issues, but it raises the value of screening.
Noise-related hearing damage is common and cumulative. If you have a history of loud environments (tools, industry, military, motorbikes, frequent live music), diabetes can add vulnerability on top of existing wear.
Smoking damages blood vessels and compounds vascular risk. If you smoke or have smoked for years, don’t leave hearing to chance.
These are common in type 2 diabetes and sit within the same cardio-metabolic risk picture. The more of these you carry, the more worthwhile a baseline hearing assessment becomes.
A simple “book now” checklist
If you have diabetes and any one of these applies, don’t wait for it to become obvious:
- You struggle in background noise
- You have persistent tinnitus
- You have chronic kidney disease, neuropathy, or diabetic eye disease
- You have high blood pressure or cardiovascular disease
- Friends or family are commenting on your hearing
- You’re turning the TV up more than you used to
Red flags: when hearing changes are urgent
Most hearing loss is gradual. Sudden hearing loss is different.
If hearing changes suddenly (over 3 days or less) and it’s not explained by wax or an infection, NICE recommends immediate referral (to be seen within 24 hours) to ENT or an emergency department. This is time-sensitive and should be treated as urgent.
Also seek urgent medical assessment if hearing loss comes with:
• severe dizziness or new balance problems
• facial weakness or numbness
• significant ear pain, discharge, or fever
• a rapid worsening over days to weeks
Getting your hearing checked in the UK (NHS and private)
NHS route
Start with your GP. They can check for reversible causes like wax or infection and refer to audiology if needed. The NHS provides free hearing tests and treatment for eligible patients.
RNID also outlines what to expect from the GP and referral pathway in straightforward terms, which is useful if you want to know how the process typically runs.
Private route
Private assessments can be quicker and can be useful for building a baseline you can track over time, particularly if you’re the kind of person who prefers proactive monitoring rather than waiting for a problem to become disruptive.
If you’ve recently been diagnosed with diabetes (or you’ve had it for years and never tested hearing properly), a quick hearing screen, such as the SoundCheck by Alto, can be a sensible baseline check to add alongside your existing diabetes reviews. Keep the objective simple: establish where you are now, then re-check at sensible intervals.
What a proper hearing assessment should include (wherever you go)
- A clear history (diabetes duration, complications, noise exposure, tinnitus, balance)
- Looking in the ears (otoscopy)
- Pure tone audiometry (hearing thresholds)
- Speech understanding testing (how well you understand words, not just tones)
- A plain-English explanation and a plan (monitor, medical referral, wax management, hearing support)
How often should you test your hearing if you have diabetes?
There isn’t a single UK-wide schedule for hearing monitoring in diabetes, partly because it’s not currently part of the standard care processes.
A pragmatic approach that fits how diabetes is managed elsewhere:
- Baseline test soon after diagnosis (or as soon as practical if you’ve never had one)
- Repeat every 1–2 years
- Re-test sooner if you notice changes, develop microvascular complications, or your day-to-day hearing becomes harder work
This isn’t about creating more appointments. It’s about avoiding the common scenario where hearing has been getting worse for years, then becomes a sudden social and safety issue.
What you can do now to protect your hearing
You can’t control every variable, but you can reduce risk and improve early detection.
Diabetes complications are driven by long-term blood sugar levels damaging blood vessels and nerves. When you manage diabetes well, you’re supporting the systems your hearing relies on too.
If you’re thinking about hearing risk, these are not “separate” issues. They’re part of the same vascular story.
Use hearing protection in loud environments and keep personal audio at sensible levels. Noise damage is cumulative.
Wax can mimic hearing loss and is treatable. A proper assessment checks this early.
Earlier support usually means better speech understanding, less listening fatigue, and less avoidance of social situations. Hearing care is most effective when it’s proactive, not reactive.
FAQs
Is hearing loss a recognised diabetes complication in the UK?
Hearing loss is not currently included in NICE’s “9 key care processes” for annual diabetes monitoring. However, the research evidence consistently shows an association between diabetes and higher rates of hearing impairment.
Does this apply to both type 1 and type 2 diabetes?
Yes. Type 2 has more studies because it’s more common, but evidence also links type 1 diabetes with auditory impairment.
What type of hearing loss is most associated with diabetes?
Most studies point towards sensorineural hearing loss (inner ear), often affecting higher frequencies first, which is why speech in background noise can become difficult early on.
I can hear people speaking, so why do I still struggle?
Hearing loss is often a clarity problem before it becomes a loudness problem. Higher-frequency loss makes consonants harder to distinguish, so speech becomes less sharp, especially in noisy places.
Is tinnitus linked to diabetes?
There is emerging evidence of a small association, but tinnitus has many causes and is most commonly linked with hearing loss and noise exposure. If you have tinnitus, a hearing test is still a sensible next step.
How do I get a hearing test on the NHS?
See your GP. They can examine your ears and refer you for an NHS hearing test if appropriate.
How do I get a private hearing test?
You do not need a referral for a private hearing test. You can book directly with a hearing clinic such as Alto Hearing. A quick screen can be used to establish a baseline or to check hearing sooner than NHS pathways allow, especially for people managing long-term conditions such as diabetes.
Medical note
This article is general information and not a substitute for personalised medical advice. If you have sudden hearing loss, rapid worsening, severe dizziness, facial weakness, significant pain, or discharge, seek urgent medical assessment.