The use of mHealth tools in the evaluation of hearing and vision in adults with diabetes

Abstract

Possible links between diabetes-associated hearing loss (HL) and visual impairment (VI) have been identified in literature. Adults with diabetes are twice as likely to acquire HL and/or VI, compared to adults without diabetes. However, in developing countries, access to hearing and vision services are limited, and usually costly. Additionally, to the researcher’s knowledge, there are no published studies on the evaluation of hearing and vision in adults with diabetes using mHealth technology. This study aimed to describe the use of mHealth tools in the evaluation of both hearing and vision in adults with diabetes living in developing countries. This study utilized a cross-sectional, observational study design, which involved the inclusion of 33 adults between the ages of 21 and 60, who have been diagnosed with diabetes. Participants were recruited from two public institutions in Pretoria, South Africa. Participants were excluded if they self-reported any comorbidities of HL and/or VI, such as history of occupational noise exposure, any neurological impairments, ototoxic exposure, history of traumatic brain injury, history of ear and/or eye infections and surgeries, family history of HL, and currently or previously pregnant in the last 3 months. Validated mHealth applications were used to assess hearing and screen vision, namely the HearTest™, the South African English Digits-in-Noise (DIN), and the PeekAcuity™ using one smartphone device. The smartphone-based pure tone audiometry revealed the presence of HL in more than one-third (37.8%) of the ears examined, along with majority (86.4%) presenting with elevated extended high frequency thresholds (thresholds above 25 dB HL). Significant correlations were found between increasing age and elevated extended high frequency thresholds bilaterally (rs= 0.43; p = 0.012), and between the presence of hypertension and all pure tone averages (0.5 – 16 kHz) (rpb range from 0.35 to 0.57; p = <0.001 to 0.043) . No significant association was found for duration of diabetes and presence of HL (p > 0.005). Additionally, more than half (63.6%) of the participants failed the DIN test. Almost one-third (27.3%) of the participants failed the smartphone-based vision screening. Additionally, approximately one-fifth of the participants (21.2%) presented with co-occurrence of HL and VI. Signficant correlations were found between VI and high frequency, and extended high frequency HL (rpb range 0.25 to 0.29; p = 0.017 to 0.046). No significant associations were found for the co-occurrence of HL and VI, and participant variables (age, duration of diabetes, and presence/absence of comorbidities). A single smartphone utilized different applications to evaluate both hearing and vision in adults with diabetes. Significant correlations were found between HL and VI in this population suggesting a possible link between diabetes and hearing and visual impairments. These findings support previous literature demonstrating link between diabetes-associated VI and HL. These findings further emphasize the importance of regular hearing and vision screening in adults with diabetes. This study suggests that mHealth tools can be an accessible alternative to promote early detection and awareness of hearing and vision services in developing countries.