Diabetesresultsinincreasedoxidativestress.

Researchoverthepastfewdecades
hasshownthatelevatedoxidativestressplaysanimportantroleinthe
pathogenesisofdiabeticcomplications2123.Althoughoxidativestresswasseldom
consideredapotentialcauseofhearinglossintype2diabeticpatients,Aladaget
al.24reportedthatoxidativestressmightplayanimportantroleinhearing
impairmentinpatientswithtype2diabetes.Specifically,higherlevelsofserum
proteinoxidationproducts,nitricoxideandenzymaticantioxidantactivitywere
foundinagroupof63patientswithtype2diabetescomparedwithacontrolgroup
of37participants.8OHdGhasoftenbeenusedasabiomarkerofoxidative
deoxyribonucleicaciddamageinrelationtodiabetesmellitus 25,26.Inthecurrent
study,however,hearingimpairmentwasnotassociatedwith8OHdGamong
patientswithtype2diabetes.Therearesomepossibleexplanationsforthis
difference.First,thisdifferentresultcouldbeasaresultofthedifferentmarkerof
oxidativestressweused.Itispossiblethathearingimpairmentisrelatedtosome
oxidativestressmarkers.Second,theformationoffreeradicalsisrelatedtothe
presenceofhighglucoselevels.Inthepresentstudy,however,thelevelofHbA 1c
wasnotdifferentbetweenpatientswithorwithouthearingimpairment.Third,the
differenceinbloodglucosevariabilitymightbethepossiblereason,asglucose
fluctuationsshowedamorespecifictriggeringeffectonoxidativestress27.Further
studiesarerequiredtoimproveourunderstandingoftheexactroleofoxidative
stressinthisprocessandpossiblewaystopreventit.

Theevidencethatdurationofdiabetesisassociatedwiththelikelihoodofhearing
impairmentisinconclusive.Somestudiesshowedthatthedurationofdiabetesisa
riskfactorfortheincidenceofhearingimpairmentinpatientswithdiabetes 6,28,but
otherstudiesshowedthatthedurationofdiabeteshadlittleeffectonit11,29.Inthe
presentstudy,althoughitdidnotreachstatisticalsignificance,patientswith
hearingimpairmenthadlongerdurationofdiabetesthanthosewithout.In
addition,theassociationbetweenthedurationofdiabetesandseverityofhearing
lossborderedonastatisticallysignificantvalue(P=0.05)underlinearregression
analysis.Thus,furtherlargescaledstudiesarerequiredtodiscovertheroleofthe
durationofdiabetesontheimpairmentofhearingloss.

Therewasnoassociationbetweenglycemiccontrol,asassessedbyHbA 1clevels,
andhearinglossinthepresentstudy,whichisconsistentwithsomeprevious
reports11,30.ItisunlikelythatasingleHbA1cmeasurementconcurrentwiththe
hearingevaluationwouldbeassociatedwithhearingloss,becausethisoutcome
representstheaverageglucosecontroloverthepreceding23months.
Accordingly,morelongitudinalstudiesarenecessarytoevaluatethelongterm
effectsofglycemiccontrolonhearingimpairmentintype2diabeticpatients.
Thepresentstudyhadanumberoflimitationsthatwarrantmention.First,wedid
notcollectindividualhistoriesofnoiseexposure.Thedifferenceinindividual
noiseexposurecouldconfoundtheassociationbetweendiabetesandhearingloss.
Second,asthiswasacrosssectionalstudy,wecouldnotestablishacauseeffect
relationship.Furtherlongitudinalstudiesarenecessarytoconfirmtheassociation
betweenhearinglossandalbuminuriaintype2diabeticpatients.Nevertheless,the
findingsofthepresentstudymightstillserveasareferenceforclinicianstoassess
therelationshipbetweenhearingimpairmentandalbuminuriainpatientswithtype
2diabetes.Awarenessoftheelevatedriskofdevelopinghearingimpairmentfor
diabeticpatientswithelevatedalbuminuriawouldprompttheearlydetectionof
hearingimpairment.

Inconclusion,thepresentresultssuggestthatincreasedUACR,butnotoxidative
stress,wascorrelatedwithhearinglossinpatientswithtype2diabetesmellitus.
Additionally,theseverityofhearinglosswasassociatedwithworseningrenal
functionandincreasingUACR.

ACKNOWLEDGMENTS

ThisstudywassupportedbygrantsfromtheChangGungMemorialHospital
ResearchProject(CMRPG891721).Theauthorshavenoconflictsofinterestto
declare.

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