Longitudinal Changes in Auditory Function Among Veterans with Diabetes

患有糖尿病的退伍军人听觉功能的纵向变化

• 批准号: 8088753
• 负责人: Marilyn F. Dille
• 金额: --
• 依托单位: PORTLAND VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-01-01 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8088753
• 关键词: Accounting; Address; Affect; Age; Auditory; Auditory Brainstem Responses; Benchmarking; Blindness; Blood Circulation; Blood Glucose; Blood Vessels; Brain Stem; Caring; Categories; Central Auditory Diseases; Characteristics; Clinical Trials; Cognition; Cognitive; Communication; Complications of Diabetes Mellitus; Comprehension; Cross-Sectional Studies; Data; Deterioration; Diabetes Mellitus; Diabetic Angiopathies; Documentation; EP300 gene; Filament; Fingers; Functional disorder; Fundus photography; Future; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health; Hearing; Hypertension; Individual; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Kidney Diseases; Knowledge; Life; Link; Longitudinal Studies; Maintenance; Measurement; Measures; Metabolic Control; Metabolic Diseases; Methods; Mission; Neurologic; Neuropathy; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Peripheral; Peripheral Nervous System Diseases; Peripheral arterial disease; Personal Satisfaction; Pharmaceutical Preparations; Prevalence; Prevention strategy; Process; Quality of life; Questionnaires; Recording of previous events; Recruitment Activity; Reporting; Research; Retinal; Retinal Diseases; Risk; Severities; Short-Term Memory; Speech; Staging; Stroke; Synaptic Transmission; Testing; Time; Veterans; Work; auditory pathway; auditory stimulus; autonomic neuropathy; base; cognitive change; cognitive function; diabetic; follow-up; foot; hearing impairment; heart disease risk; illness length; improved; insight; otoacoustic emission; premature; prevent; programs; prospective; relating to nervous system; response; speech processing; treatment duration

DESCRIPTION (provided by applicant): Diabetes Mellitus (DM) is a metabolic disease that causes microvascular and neurologic complications and affects 20% of Veterans receiving care at the VA. Evidence supports a link between DM and hearing loss. In a recent study, Bainbridge et al. (2008) reported that the prevalence of hearing loss was 15% for participants without DM, but was double (30%) for those with DM. Previously, we demonstrated that diabetes is associated with hearing loss primarily among Veterans below age 50. After controlling for hearing, auditory brainstem dysfunction was present among younger Veterans with DM requiring insulin. Our findings were established in two cross-sectional studies among Veterans but do not address progression in auditory dysfunction over time or its relationship to measures of DM severity or metabolic control. Nor do they show the extent that these changes relate to speech processing deficits or quality of life. We will measure longitudinal changes in auditory function among Veterans with diabetes mellitus (DM), using tests that target peripheral, central and cognitive stages of processing. We will determine the extent to which DM-related changes in these measures interfere with speech communication and daily living. We will also establish how changes in the auditory pathway relate to the characteristics and maintenance of DM and are linked to other major diabetes complications such as retinopathy or peripheral neuropathy. Specifically, we will measure current auditory function and degree of DM severity and metabolic control on participants from our previous two studies, a pool of nearly 1100 participants. We will supplement this group with new participants from specific categories of DM and hearing using only prospective measures. This approach will yield prospective follow-up data at 2 and 3 years after the original measurements on all participants, and retrospective follow-up data up to 15 years from original measurements for some participants. Ultimately, we foresee a clinical trial for those diabetic Veterans most likely to benefit from a strict metabolic control intervention with the outcome of improved auditory function. Participants will be newly recruited or recruited from our previous studies based on age and audiologic status and tested 3 times over 4 years. We will conduct tests of peripheral (pure tone thresholds, otoacoustic emissions) and central auditory (auditory brainstem responses, P300 cognitive response) function. Additionally, we will include measures of auditory working memory and sequencing and speech comprehension. Participants will also complete questionnaires to query quality of life, impacts of auditory dysfunction on daily living, and DM history, including duration, treatment history and complications. From these responses and objective measures of DM we will construct composite scales, which will be used as potential indicators of small vessel or neural types of DM complications. Blood-sugar (HbA1c) levels will be determined via finger stick. Foot neuropathy tests using the filament method will be conducted, and retinal (fundus) photography will be performed. We expect to find greater changes in auditory and cognitive processing over time in Veterans with DM compared to those without, after controlling for differences in the time between serial measurements. We expect results of this work will suggest that the risk of change in auditory and cognitive function depends on DM severity and/or metabolic control. If so, an appropriate intervention could potentially mitigate impairments of hearing and cognition, leading to improved quality of life for the numerous Veterans affected by DM. Therefore, the proposed study indisputably promotes the VA mission of improved the health and well-being of our nation's Veterans. PUBLIC HEALTH RELEVANCE: Diabetes Mellitus (DM) affects one in five Veterans receiving care at the VA. DM can have devastating complications, including increased risk of heart disease and stroke, high blood pressure, blindness, peripheral and autonomic neuropathy, and kidney disease. We have shown through two cross-sectional studies that DM is associated with hearing loss primarily among younger Veterans and central auditory dysfunction among younger Veterans with insulin-dependent DM. We propose a longitudinal study to understand the peripheral, central and cognitive changes in auditory function in Veterans with DM and to relate those changes to DM severity and metabolic control. Our long range goal is to minimize DM-related auditory dysfunction by determining if linkage exists between DM factors, major diabetes complications and premature changes in auditory function, the knowledge of which will improve auditory outcomes by minimizing the consequences of DM.

描述(由申请人提供)： 糖尿病(DM)是一种代谢性疾病，会导致微血管和神经并发症，影响20%在退伍军人管理局接受护理的退伍军人。有证据支持糖尿病和听力损失之间的联系。在最近的一项研究中，班布里奇等人。(2008)报告说，没有糖尿病的参与者听力损失的患病率为15%，但患有糖尿病的参与者听力损失的患病率增加了一倍(30%)。在此之前，我们主要在50岁以下的退伍军人中证明了糖尿病与听力损失有关。在控制听力后，患有需要胰岛素的糖尿病的年轻退伍军人中存在听性脑干功能障碍。我们的发现是在退伍军人中的两项横断面研究中确定的，但没有解决听力功能障碍随时间的进展，或者它与糖尿病严重程度或代谢控制措施的关系。它们也没有显示出这些变化与语音处理缺陷或生活质量的关系程度。我们将使用针对外周、中枢和认知处理阶段的测试，来测量患有糖尿病(DM)的退伍军人的听觉功能的纵向变化。我们将确定这些措施中与DM相关的变化对言语交流和日常生活的干扰程度。我们还将确定听觉通路的变化如何与糖尿病的特征和维持有关，以及与其他主要糖尿病并发症，如视网膜病变或周围神经病变的联系。具体地说，我们将测量前两项研究中近1100名参与者的当前听觉功能和糖尿病严重程度以及代谢控制情况。我们将用来自特定类别的糖尿病和听力的新参与者来补充这一组，只使用前瞻性的措施。这种方法将产生所有参与者在原始测量后2年和3年的前瞻性随访数据，以及一些参与者从原始测量获得的长达15年的回溯性随访数据。最终，我们预计将对那些最有可能受益于严格的代谢控制干预并改善听觉功能的糖尿病退伍军人进行临床试验。参与者将根据年龄和听力状况从我们以前的研究中新招募或招募，并在4年内进行3次测试。我们将进行外周(纯音阈值，耳声发射)和中枢听觉(听性脑干反应，P300认知反应)功能的测试。此外，我们还将包括听觉工作记忆、排序和语音理解的测量。参与者还将完成调查问卷，以询问生活质量、听力障碍对日常生活的影响，以及糖尿病病史，包括病程、治疗史和并发症。根据DM的这些反应和客观测量，我们将构建复合量表，这些量表将作为DM并发症的小血管或神经类型的潜在指示器。血糖(HbA1c)水平将通过手指棒进行测定。将进行使用细丝法的足部神经病测试，并进行视网膜(眼底)照相。我们预计，在控制了连续测量之间的时间差异后，患有糖尿病的退伍军人的听觉和认知处理随时间的变化比没有糖尿病的退伍军人更大。我们预计这项工作的结果将表明，听觉和认知功能改变的风险取决于糖尿病的严重程度和/或代谢控制。如果是这样的话，适当的干预可能会潜在地减轻听力和认知的损害，从而提高无数受糖尿病影响的退伍军人的生活质量。因此，拟议的研究无可争议地促进了退伍军人管理局的使命，即改善我国退伍军人的健康和福祉。 公共卫生相关性： 糖尿病(DM)影响到五分之一在退伍军人管理局接受护理的退伍军人。糖尿病可能会有毁灭性的并发症，包括心脏病和中风、高血压、失明、周围神经和自主神经病变以及肾脏疾病的风险增加。我们通过两项横断面研究表明，糖尿病主要与年轻退伍军人的听力损失有关，与患有胰岛素依赖型糖尿病的年轻退伍军人的中枢听觉功能障碍有关。我们建议进行一项纵向研究，以了解患有DM的退伍军人的外周、中枢和认知功能的变化，并将这些变化与DM的严重性和代谢控制联系起来。我们的长期目标是通过确定糖尿病因素、主要糖尿病并发症和听觉功能过早改变之间是否存在联系来最小化DM相关的听觉功能障碍，了解这些因素将通过最小化DM的后果来改善听力结果。