Hyperglycemia, Hearing Loss and Vestibular Dysfunction: The CARDIA Study

项目摘要/摘要 听力损失(HL)和前庭功能障碍(VED)是内耳引起的常见疾病 通常不会被发现的功能障碍，直到赤字显露出来。此外，HL最初与糖尿病有关 导致高频HL，沟通障碍可能导致孤立、抑郁和低生活质量。 更长时间和更严重的高血糖可能会影响低/中频HL，但目前这种联系 不清楚。生理性损伤是永久性的、感觉神经型的，因此，预防 通过早期发现和干预来实现。前庭功能障碍通过同样的方式发生 与HL一样的机制，并可能导致失衡和头晕，这与跌倒和失去 独立。虽然2型糖尿病(T2D)和HL之间的联系已经确立，但鲜为人知 关于T2D和前庭功能障碍。有关糖尿病前期(PRED)和内耳功能障碍的数据也有限。 青年冠状动脉风险发展35年(CARDIA)研究临床访问(2020- 2021年)将用于招募参与者进行一项辅助研究，以检查横断面和 35年来在HL和VED青少年游戏中收集的PRED和T2D的纵向测量 在一群特征鲜明的黑人和白人男性和女性中，出现了中年。 将使用适合于以人群为基础的自动测听方案来测量HL 在没有专业听力专家要求的情况下进行大样本听力评估。VED将会是 使用新的视频头部脉冲测试进行评估，以获取耳朵水平的前庭系统完整性。PRED和T2D 将根据35年的空腹血糖确定，历史上是通过空腹血糖、口服葡萄糖 耐受性测试、药物使用和/或血红蛋白A1c，并将包括程度和持续时间 高血糖症。 CARDIA队列将在35岁的诊所就诊时年龄在53-65岁之间；因为听力敏感性 从60岁左右开始，CARDIA每十年大约减少10分贝，CARDIA现在处于理想状态 在年龄相关性下降之前患上HL的年龄，同时有足够的PRED的患病率和发病率 虽然VED本身并不是一种临床疾病，但这项研究将提供人群的标准化数据- 以研究为基础。因此，这项附属研究建议探讨以下目标：1)评估 T2D和PRED与前庭功能障碍的关系；以及2)表征 PRED和T2D，具有总体、低/中和高频HL横截面，并使用轨迹分析 纵向血糖变化趋势。 CARDIA提供了一个独特的机会将PRED和T2D联系起来 中年时患有HL和VED。将这项研究整合到现有的CARDIA诊所访问中是一种有效的 以及成本效益高的方式，以最大限度地扩大在稳定留住的队列中的招聘。

Project Summary/Abstract Hearing loss (HL) and vestibular dysfunction (VeD) are common conditions resulting from inner ear dysfunction that often go undetected until the deficit is pronounced. Further, HL related to diabetes initially leads to high frequency HL, a communication deficit may lead to isolation, depression and low quality of life. Longer and more severe hyperglycemia may affect low/mid frequency HL, but the association is currently unclear. Physiologic damage is of the permanent, sensorineural type and therefore, prevention is accomplished by early detection and intervention. Vestibular dysfunction occurs through the same mechanisms as HL, and may lead to imbalance and dizziness, which are associated with falls and loss of independence. While the association between type 2 diabetes (T2D) and HL is well established, less is known about T2D and vestibular dysfunction. Data on prediabetes (preD) and inner ear dysfunction are also limited. The Year 35 Coronary Artery Risk Development in Young Adults (CARDIA) study clinic visit (2020- 2021) will be used to recruit participants for an ancillary study to examine the roles that cross-sectional and longitudinal measures of preD and T2D collected over 35 years from young adulthood play in HL and VeD in middle age among a well-characterized cohort of black and white men and women. HL will be measured using an automated audiometry protocol that is suitable for population-based hearing assessment in large samples without the requirement of specialized audiologists. VeD will be assessed with novel video head impulse testing to capture ear-level vestibular system integrity. PreD and T2D will be determined based on fasting glucose at Year 35, and historically via fasting glucose, oral glucose tolerance testing, medication use and/or hemoglobin A1c, and will capture both degree and duration of hyperglycemia. The CARDIA cohort will be ages 53-65 years at the Year 35 clinic visit; because hearing sensitivity decreases by approximately 10 dB per decade starting around the age of 60 years, CARDIA is now at the ideal age to capture HL prior to age-related declines while having sufficient prevalence and incidence of both preD and T2D; while VeD is not a clinical condition per se, this research will provide normative data for a population- based study. Therefore, this ancillary study proposes to examine the following aims: 1) to assess the association between both T2D and preD and vestibular dysfunction; and 2) to characterize the associations of preD and T2D with overall, low/mid, and high frequency HL cross-sectionally and using trajectory analysis for longitudinal glycemia trends. CARDIA provides a unique opportunity to connect preD and T2D developing from young adulthood with HL and VeD in middle age. Integration of this research into the existing CARDIA clinic visit is an efficient and cost-effective way to maximize recruitment in a cohort that has had stable retention.