Hearing Impairment in Long-Term Type 1 Diabetes

描述（由申请人提供）：DCCT/EDIC研究的主要任务是确定血糖控制和非高血糖危险因素对1型糖尿病并发症的影响。1型糖尿病患者的听力损失患病率可能高于非糖尿病患者。听力损失是否因现在或过去的血糖控制程度或其他糖尿病并发症的存在而改变尚不清楚。DCCT/EDIC队列由于其长期随访（30年），为1型糖尿病听力损伤的特征提供了极好的机会。我们建议使用听力问卷和纯音听力测试来定义整个DCCT/EDIC队列的听觉能力，并与大约260名非糖尿病患者的类似评估结果进行比较。我们预计1350名幸存的EDIC志愿者中至少有1100人会自愿参加。每个诊所将发放一份听力问卷。标准化的纯音听力测试将由每个诊所进行。主要结果是基于500、1000、2000和4000 Hz的纯音平均阈值的平均值的听力损伤的患病率。听力障碍将定义为纯音平均值大于25分贝。本提案的具体目的是：1)基于自我管理问卷和测量不同频率的空气传导纯音阈值来确定听力障碍是否在DCCT/EDIC队列中比在没有糖尿病的对照组中更普遍；2)评估DCCT/EDIC研究中~30年的平均糖化血红蛋白测量的高血糖与听力障碍的患病率和程度的关系；3)确定先前DCCT强化治疗组与常规治疗组之间听力损害的患病率和程度是否存在差异；4)评估其他决定因素（如人口统计学、临床状态、生化参数、行为特征和环境）是否与DCCT/EDIC队列中听力障碍的患病率和程度有关。上述方案将有超过90%的能力检测对照组和DCCT/EDIC志愿者之间听力损失几率的两倍差异。结果将确定1型糖尿病患者与非糖尿病对照者的听力能力，血糖控制的影响，其他糖尿病并发症对听力的影响，以及听力损伤危险因素的识别（人口统计学，临床，生化，行为和环境）。我们预计这些数据将导致听力学筛查和测试建议，这将对所有1型糖尿病患者的生活质量和健康产生重大影响。

DESCRIPTION (provided by applicant): The primary mission of the DCCT/EDIC study is to determine the effects of glycemic control and of non- hyperglycemic risk factors on the complications of type 1 diabetes. Persons with type 1 diabetes may have a greater prevalence of hearing loss than comparable non-diabetic individuals. Whether hearing loss is altered by the degree of present or past glucose control or the presence of other diabetes complications is unknown. The DCCT/EDIC cohort provides an excellent opportunity to characterize hearing impairment in type 1 diabetes owing to its long term follow-up of the cohort (30 years). We propose to utilize both a hearing questionnaire and pure tone audiometry testing to define the auditory capability of the entire DCCT/EDIC cohort, to be compared with the results of like assessments in a comparable group of approximately 260 individuals without diabetes, We anticipate that at least 1,100 of the 1,350 surviving EDIC volunteers will volunteer. A hearing questionnaire will be administered by each clinic. Standardized pure tone audiometry testing will be done by each clinic. The primary outcome is the prevalence of hearing impairment based on a mean of the pure tone average of thresholds at 500, 1000, 2000, and 4000 Hz. Hearing impairment will be defined as a pure tone average greater than 25 dB. The Specific Aims of this proposal are: 1) To determine whether hearing impairment, based on both self-administered questionnaire and measurement of air conduction pure tone thresholds at various frequencies, is more prevalent in the DCCT/EDIC cohort than in a control group without diabetes; 2) To assess the association of hyperglycemia, as measured by the mean A1C over ~30 years of the DCCT/EDIC study, with the prevalence and extent of hearing impairment; 3) To determine whether the prevalence and extent of hearing impairment differs between the prior DCCT intensive treatment group versus the conventional treatment groups; and 4) To evaluate whether other determinants (e.g., demographic, clinical status, biochemical parameters, behavioral characteristics, and environmental) are related to the prevalence and extent of hearing impairment in the DCCT/EDIC cohort. The above protocol will have greater than 90% power to detect a two-fold difference in the odds of having a hearing loss between the controls and the DCCT/EDIC volunteers. The results will establish the hearing capabilities of individuals with type 1 diabetes compared to non diabetic controls, the impact of glycemic control, the presence of other diabetic complications on hearing, and the identification of hearing impairment risk factors (demographic, clinical, biochemical, behavioral, and environmental). We anticipate that these data will lead to audiological screening and testing recommendations that will have a major quality of life health benefit for all individuals with type 1 diabetes.