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）是一种代谢疾病，会导致微血管和神经系统并发症，并影响VA接受护理的退伍军人的20％。证据支持DM与听力损失之间的联系。在最近的一项研究中，Bainbridge等。 （2008年）报道说，没有DM的参与者的听力损失的患病率为15％，但DM患者是两倍（30％）。以前，我们证明了糖尿病与50岁以下的退伍军人之间的听力损失有关。在控制听力后，具有DM需要胰岛素的年轻退伍军人中有听觉的脑干功能障碍。我们的发现是在退伍军人之间的两项横断面研究中建立的，但并未解决随着时间的流逝或与DM严重程度或代谢控制措施的关系，听觉功能障碍的进展。它们也没有表明这些变化与语音处理缺陷或生活质量有关的程度。 我们将使用针对处理的外围，中央和认知阶段的测试来衡量糖尿病（DM）退伍军人之间听觉功能的纵向变化。我们将确定这些措施中与DM相关的变化在多大程度上干扰语音交流和日常生活。我们还将确定听觉途径的变化如何与DM的特征和维护有关，并与其他主要糖尿病并发症（例如视网膜病变或周围神经病）相关。具体而言，我们将对前两项研究的参与者（近1100名参与者的池）来衡量当前的听觉功能以及DM严重程度和代谢控制的程度。我们将为来自特定类别的DM的新参与者补充该小组，并仅使用前瞻性措施来听取。这种方法将在所有参与者的原始测量后2年和3年产生前瞻性后续数据，并从原始测量中对某些参与者的原始测量最多15年进行回顾性随访数据。最终，我们预见了那些最有可能受益于严格的代谢控制干预措施的糖尿病退伍军人的临床试验，并改善了听觉功能。 参与者将根据年龄和听力状态新招募或从我们以前的研究中招募或招募参与者，并在4年内进行了3次测试。我们将进行外围（纯音阈值，耳声排放）和中央听觉（听觉脑干响应，p300认知响应）功能的测试。此外，我们将包括听觉工作记忆，排序和语音理解的度量。参与者还将完成调查表，以查询生活质量，听觉功能障碍对日常生活的影响以及DM历史，包括持续时间，治疗史和并发症。从这些响应和DM的客观度量中，我们将构建复合量表，将其用作小血管或神经类型DM并发症的潜在指标。血糖（HBA1C）水平将通过手指棒确定。将使用细丝方法进行脚部神经病测试，并将进行视网膜（眼底）摄影。 在控制了串行测量之间的时间差异之后，我们希望与没有DM的退伍军人相比，与没有DM的退伍军人相比，DM退伍军人的听觉和认知处理随着时间的流逝而发生更大的变化。我们预计这项工作的结果将表明听觉变化和认知功能的风险取决于DM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的损害，从而改善受DM影响的众多退伍军人的生活质量。因此，拟议的研究无疑促进了VA的使命，即改善了国家退伍军人的健康和福祉。 公共卫生相关性： 糖尿病（DM）影响在VA接受护理的五分之一的退伍军人。 DM可能患有毁灭性并发症，包括增加心脏病和中风的风险，高血压，失明，周围和自主神经病以及肾脏疾病。我们通过两项横断面研究表明，DM与年轻退伍军人的听力损失有关，并且在具有胰岛素依赖性DM的年轻退伍军人中，中央听觉功能障碍。我们提出了一项纵向研究，以了解具有DM的退伍军人的听觉功能的外围，中心和认知变化，并将这些变化与DM严重程度和代谢控制联系起来。我们的远距离目标是通过确定DM因子，主要糖尿病并发症和听觉功能过早变化之间的连锁，通过确定其知识将通过最小化DM的后果来改善听觉结果，从而最大程度地减少了与DM相关的听觉功能障碍。