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: 8876579
• 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/8876579
• 关键词: Address; Affect; Age; Auditory; Auditory Brainstem Responses; Blindness; Blood Glucose; Brain Stem; Caring; Categories; Central Auditory Diseases; Characteristics; Clinical Trials; Cognition; Cognitive; Communication; Complications of Diabetes Mellitus; Comprehension; Cross-Sectional Studies; Data; Diabetes Mellitus; EP300 gene; Filament; Fingers; Functional disorder; Fundus photography; Glycosylated hemoglobin A; Goals; Health; Hearing; Hypertension; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Kidney Diseases; Knowledge; Life; Link; Longitudinal Studies; Maintenance; Measurement; Measures; Metabolic Control; Metabolic Diseases; Methods; Mission; Neurologic; Neuropathy; Outcome; Participant; Peripheral; Peripheral Nervous System Diseases; Personal Satisfaction; Prevalence; Process; Quality of life; Questionnaires; Recording of previous events; Recruitment Activity; Reporting; Retinal; Retinal Diseases; Risk; Severities; Short-Term Memory; Speech; Staging; Stroke; Testing; Time; Veterans; Work; auditory pathway; autonomic neuropathy; base; cognitive change; cognitive function; diabetic; follow-up; foot; hearing impairment; heart disease risk; improved; otoacoustic emission; premature; 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.

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系统并发症，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) 报道称，对于没有糖尿病的参与者来说，听力损失的发生率为 15%，而对于患有糖尿病的参与者来说，听力损失的发生率是两倍 (30%)。此前，我们证明糖尿病主要与 50 岁以下退伍军人的听力损失有关。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觉脑干功能障碍。我们的研究结果是在退伍军人中进行的两项横断面研究中得出的，但并未解决听觉功能障碍随时间的进展或其与糖尿病严重程度或代谢控制测量的关系。它们也没有表明这些变化与言语处理缺陷或生活质量相关的程度。 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相关，以及与视网膜病变或周围神经病变等其他主要糖尿病并发症的关系。具体来说，我们将测量前两项研究的参与者（总共有近 1100 名参与者）当前的听觉功能、DM 严重程度和代谢控制。我们将仅使用前瞻性措施来补充来自特定 DM 和听力类别的新参与者。这种方法将在所有参与者的原始测量后 2 年和 3 年产生前瞻性随访数据，并为某些参与者提供原始测量后长达 15 年的回顾性随访数据。最终，我们预计对那些患有糖尿病的退伍军人进行临床试验，最有可能受益于严格的代谢控制干预，从而改善听觉功能。 参与者将根据年龄和听力状况新招募或从我们之前的研究中招募，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（听觉脑干反应、P300认知反应）功能的测试。此外，我们还将包括听觉工作记忆、排序和言语理解的测量。参与者还将完成问卷调查，询问生活质量、听觉功能障碍对日常生活的影响以及糖尿病病史，包括持续时间、治疗史和并发症。根据这些反应和 DM 的客观测量，我们将构建复合量表，该量表将用作 DM 并发症的小血管或神经类型的潜在指标。血糖 (HbA1c) 水平将通过指尖采血测定。将使用灯丝法进行足部神经病变检查，并进行视网膜（眼底）摄影。 在控制了连续测量之间的时间差异后，我们预计患有 DM 的退伍军人与没有 DM 的退伍军人相比，随着时间的推移，他们的听觉和认知处理会发生更大的变化。我们预计这项工作的结果将表明听觉和认知功能变化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，适当的干预措施可能会减轻听力和认知损伤，从而提高众多受糖尿病影响的退伍军人的生活质量。因此，拟议的研究无疑促进了退伍军人事务部改善我国退伍军人健康和福祉的使命。