Vision and hearing impairments increase risks for poor CV outcomes in type 2 diabetes
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People with type 2 diabetes and a hearing or vision impairment have an elevated risk for myocardial infarction, stroke and all-cause mortality, according to study findings published in the Journal of Diabetes Investigation.
“Patients with both vision and hearing impairments had the highest risk for MI and mortality,” Jung Il Moon, MD, PhD, an ophthalmologist at Yeouido St. Mary’s Hospital, The Catholic University of Korea College of Medicine in Seoul, South Korea, and colleagues wrote. “Those with only vision impairment showed higher cardiovascular risk and mortality compared with those with only hearing impairment. The present findings suggest that vision and hearing impairments are independently and synergistically important risk factors for adverse cardiovascular events and mortality in patients with type 2 diabetes.”
Researchers conducted a population-based cohort study of 771,128 adults with type 2 diabetes in the Korean National Health Information Database. All patients who underwent a National Health Screening Program exam in 2009 were included in the study and followed until Dec. 31, 2018. Visual impairment was defined as having any grade of visual disability or visual acuity worse than 20/40 in both eyes. Hearing impairment was having any grade of hearing disability or having impaired hearing on pure-tone audiometric testing in at least one ear. The endpoints were any new diagnosis of MI, stroke or all-cause mortality.
Of the study cohort, 43,671 had a hearing impairment, 60,514 had a vision impairment and 8,720 had both a vision and hearing impairment. Risks for MI, stroke and all-cause morality were higher in all three impairment groups compared with those with no impairment.
Participants with both a visual and hearing impairment had the highest risks for MI (adjusted HR = 1.36; 95% CI, 1.25-1.48) and all-cause mortality (aHR = 1.59; 95% CI, 1.53-1.65) and the second-highest risk for stroke (aHR = 1.29; 95% CI, 1.2-1.38) of the three impairment groups. Adults with a vision impairment had the highest risk for stroke of the three groups (aHR = 1.32; 95% CI, 1.28-1.36) and second-highest risks for MI (aHR = 1.32; 95% CI, 1.28-1.38) and all-cause mortality (aHR = 1.42; 95% CI, 1.39-1.45). Those with only a hearing impairment had lower risks for all three outcomes compared with the vision impairment only and vision impairment plus hearing impairment groups, but still had a higher risk for MI (aHR = 1.12; 95% CI, 1.07-1.17), stroke (aHR = 1.13; 95% CI, 1.09-1.18) and all-cause mortality (aHR = 1.16; 95% CI, 1.14-1.19) than those with no impairment.
In subgroup analysis, adults younger than 65 years with vision or hearing impairments had a more prominent risk for stroke and all-cause mortality than those aged 65 years or older (P for interaction < .0001 for both). The associations between vision and hearing impairments and MI were stronger for men, whereas women had a stronger association between vision and hearing impairments and all-cause mortality (P for interaction < .0001 for both). Those with diabetic retinopathy had increased risk for all three CV outcomes compared with those without diabetic retinopathy.
“The present findings suggest the importance of ophthalmologic and otologic care in patients with type 2 diabetes,” the researchers concluded.
Perspective
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Joanne Rinker, MS, RDN, CDCES, LDN, FADCES
For me, this research really validates the importance of screenings at regular intervals. Hearing and vision should be assessed at diagnosis and annually or until treatment plans are solidified, diabetes is managed, and hearing and vision have improved. The need for this recommendation was recognized more widely by the American Diabetes Association in 2021 when the acknowledgement of hearing loss and the need for audiological evaluations at diabetes diagnosis and then annually were aligned with recommendations for screenings for diabetes-related retinopathy in diabetes care. Hearing loss is an under-discussed complication of diabetes. Untreated hearing loss can cause major issues with the ability to communicate, process speech and socialize and, in turn, increase blood glucose to levels outside target ranges. I encourage those reading this research to consider implementing hearing screenings into practice and building relationships with audiologists for reciprocal referrals when working with people with diabetes.
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