Abstract
As of September 10, 2019, there were 75 medications (oral/injectable/inhalants) approved by the U.S. Food and Drug Administration for diabetes management: 1 inhalant, 21 oral combinations, 22 injectable, and 31 oral medications (not in combination with any other diabetes drug). This article isolates the auditory and vestibular side effects of those drugs as reported by the drug's manufacturer as well as those side effects that could interfere with a balance assessment. Twenty of the 75 approved medications (26%) could have an auditory-related side effect. Hearing loss and tinnitus are not on the list. Only two, or just 3%, have vertigo and spinning as reported side effects (one each). More than 50% of the drugs will have some effect on a balance assessment. Audiologists who evaluate a patient with diabetes (PWD) are presented with symptoms that could be related to their diabetes medication. Although the manufacturer might report a side effect as rare or as a percentage from their clinical trials subjects, not all PWD will experience these adverse events. Auditory and vestibular side effects do not dominate the diabetes drug side effect list, but, rather, the most reported side effects could impact a balance assessment. The lists that appear in Appendices A and B should serve as a guide for all professionals involved in managing the PWD (i.e., audiologists, otolaryngologists, diabetes educators, pharmacists, optometrists, dentists, etc.). The list also serves as a counseling tool if a communication problem emerges during the progression of the diabetes.
Keywords: adverse reaction, side effect, U.S. Food and Drug Administration, type 1 diabetes, type 2 diabetes
Before the 1920s, there were no effective pharmacological agents for the management of diabetes. Because of this, type 1 diabetes mellitus (T1DM) was a fatal malady, with the life expectancy after diagnosis of about 3 years. 1 Insulin first became available in 1922 by Eli Lilly pharmaceutical company. 1
Throughout the 20th century and into the 21st century, pharmaceutical research for both oral medication and injectable insulin has led to the development (and subsequent Food and Drug Administration [FDA] approval) of drugs for diabetes management: There are 75 FDA-approved drugs for diabetes management: 1 inhalant, 22 injectable insulins, 31 oral, and 21 oral combinations. 2 Table 1 shows the percentage of the breakdown of drug-delivery methods. For further information, there is a wealth of research information about the effectiveness and safety of all FDA-approved medications for diabetes from the National Library of Medicine . 3
Table 1. Types of FDA Medications for Diabetes Management and their Percentage of the Total ( n = 75) .
| Type of DM medication | Number | Percentage of total ( n = 75) |
|---|---|---|
| Inhalant | 1 | 1.3% |
| Oral combination | 21 | 28.0% |
| Injectable | 22 | 29.3% |
| Oral | 31 | 41.3% |
Abbreviations: DM, diabetes mellitus; FDA, Food and Drug Administration.
Clinical Trials and Reported Adverse Reactions a
The FDA and the drug's manufacturers maintain a record as well as monitor all adverse drug reactions (ADRs) that have been reported during and after clinical trials. Currently (as of September 10, 2019), there are over 725 diabetes-related clinical trials underway. 4
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with the rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. For example, if 1 out of 100 patients reports “tinnitus” (ringing in the ears) while taking this drug, then “tinnitus” must be listed as an adverse reaction. For more information on the incidence figures for all reported side effects, the reader should contact the drug's manufacturer directly.
The possibility of an ADR must be viewed more closely in the management of diabetes especially when there are auditory-related concerns and/or concerns about balance/vestibular function.
Hearing loss from diabetes can be a slow, gradual change in sensitivity. The PWD may not be aware of or may be in denial about the loss, but the loss is often initially observed by the people close to the patient. Tinnitus also might be reported from this change in hearing but may not be related to the patient's diabetes medication. None of the FDA-approved medications for diabetes currently are reported to cause hearing loss or tinnitus.
When hearing loss is suspected, an evaluation by an audiologist is warranted. Post-test intervention might include hearing aids as well as incorporation of communication strategies to be used in addition to amplification. 5
Below is a list of resources for additional information about ADRs and side effects of diabetes medications (oral/injectable/inhalants) b :
Drug manufacturer's Web site
Local pharmacist
Prescribing physician
Auditory and Vestibular Side Effects of Diabetes Medications
Of the 75 medications reviewed, 20 (26%) have an ADR for the auditory system and 2 (3%) have true vestibular-related side effects (reported as vertigo and spinning). Appendix A lists the medications by generic name and brand name (the list is also available at www.drbobdisogra.com).
Appendix A. The following tables identify all the FDA-approved medications for diabetes management in each of the drug-delivery categories brand name, generic name (in parentheses), and route of administration.
| Generic name | Brand name |
|---|---|
| Inhalant ( n = 1) | |
| Insulin human inhalation powder | Afrezza |
| Injectable insulin ( n = 22) | |
| Albiglutide | Tanzeum |
| Aspart | Novolog |
| Aspart recombinant | Fiasp |
| Detemir [rDNA origin] | Levemir |
| Dulaglutide | Trulicity |
| Exenatide | Bydureon Extended Release |
| Exenatide | Byetta |
| Glulisine | Apidra |
| Iglargine | Lantus |
| Insulin degludec injection | Tresiba |
| Insulin glargine | Basaglar |
| Insulin glargine | Toujeo NPH |
| Isophane insulin | Gensulin NPH |
| Isophane insulin | Iletin II NPH (NPH Iletin II |
| Isophane insulin | Regular NPH |
| Isophane insulin | SciLin NPH |
| Liraglutide | Victoza |
| Lispro U-100 and U-200 | Admelog (see Humalog) |
| Lispro U-100 and U-200 | Humalog (see Admelog) |
| Lixisenatide | Adlyxin |
| Lixisenatide/insulin glargine | Soliqua |
| Pramlintide | Symlin |
| Semaglutide | Ozempic |
| Oral (noncombination) ( n = 31) | |
| Acarbose | Precose |
| Alogliptin | Nesina |
| Bromocriptine | Cycloset |
| Canagliflozin | Invokana |
| Chlorpropamide | Diabinese |
| Colesevelam | WelChol |
| Dapagliflozin | Farxiga |
| Empagliflozin | Jardiance |
| Ertugliflozin | Steglatro |
| Glimepiride | Amaryl |
| Glipizide | Glucotrol |
| Glipizide | Glucotrol XL |
| Glyburide | Diaßeta (DiaBeta) |
| Glyburide | Glynase Press Tab |
| Glyburide | Micronase |
| Linagliptin | Tradjenta |
| Metformin | Fortamet Extended Release |
| Metformin | Glucophage |
| Metformin | Glucophage XR |
| Metformin | Glumetza |
| Metformin liquid | Riomet |
| Miglitol | Glyset |
| Nateglinide | Starlix |
| Pioglitazone | Actos |
| Repaglinide | Prandin |
| Rosiglitazone | Avandia |
| Rosiglitazone maleate | Avandia |
| Saxagliptin | Onglyza |
| Sitagliptin phosphate | Januvia |
| Tolazamide | Tolinase |
| Tolbutamide | Orinase |
| Oral combination ( n = 21) | |
| Alogliptin + metformin | Kazano |
| Alogliptin + pioglitazone | Oseni |
| Canagliflozin + metformin | Invokamet |
| Canagliflozin + metformin | Invokamet XR |
| Empagliflozin + metformin | Synjardy |
| Empagliflozin + metformin | Synjardy XR |
| Ertugliflozin +sitagliptin | Steglujan |
| Glipizide + metformin | Metaglip |
| Glyburide + metformin | Glucovance |
| Linagliptin + metformin | Jentadueto |
| Linagliptin + metformin | Jentadueto XR |
| Pioglitazone + glimepiride | Duetact |
| Pioglitazone + metformin | Actoplus Met |
| Pioglitazone + metformin | Actoplus Met XR |
| Repaglifloxin + metformin | Xigduo XR |
| Repaglinide + saxagliptin | Qtern |
| Rosiglitazone + glimepiride | Avandaryl |
| Rosiglitazone + metformin | Avandamet |
| Repaglinide + metformin | PrandiMet |
| Saxagliptin + metformin | Kombiglyze XR |
| Sitagliptin + metformin | Janumet |
Appendix B identifies the 75 FDA-approved medications for diabetes (including oral, injectable, and inhalants for diabetes management) as of September 10, 2019. The list isolates the auditory and vestibular side effects of these medications as well as side effects that could interfere with a balance assessment. Appendix C breaks down the diabetes medications by the number of expected side effects.
Appendix B. Auditory and vestibular-related side effects of the 75 FDA-approved drugs for diabetes management, a including side effects that could interfere with auditory or balance assessment (as of April 10, 2019) b .
| Drug | Auditory side effect | Vestibular side effect | Balance assessment interference |
|---|---|---|---|
| Actos (pioglitazone) | No | No | Yes—weakness, blurred vision, changes in vision, visual disturbances |
| Actoplus Met (pioglitazone + metformin) | Yes—ear congestion | No | Yes—weakness, blurred vision |
| Actoplus Met XR (pioglitazone + metformin) | Yes—ear congestion | No | Yes—weakness, blurred vision |
| Adlyxin (lixisenatide) | No | No | Yes—weakness |
| Admelog—see Humalog | |||
| Afrezza (insulin human inhalation powder) | No | No | Yes—blurred vision, lightheadedness |
| Amaryl (glimepiride) | No | No | No |
| Apdra (glulisine) | Yes—ear congestion, pounding in the ears | No | Yes—blurred vision, weakness, lightheadedness (when getting up suddenly from a lying or sitting position) |
| Avandamet (rosiglitazone + metformin) | No | No | Yes—blurred vision, weakness |
| Avandaryl (rosiglitazone + glimepiride) | Yes—ear congestion | No | Yes—weakness, blurred vision |
| Avandia (rosiglitazone) | Yes—ear congestion | No | Yes—blurred vision, changes in vision |
| Avandia (rosiglitazone maleate) | No | No | No |
| Basaglar (insulin glargine) | No | No | Yes—blurred vision, lightheadedness, puffiness or swelling of the eyelids or around the eyes |
| Bydureon Extended Release (exenatide) | No | No | Yes—lightheadedness, weakness |
| Byetta (exenatide) | No | No | Yes—lightheadedness, weakness, blurred vision |
| Cycloset (bromocriptine) | Yes—tingling of the ears | Yes—vertigo | Yes—lightheadedness especially when getting up from a lying or sitting position, vision changes, visual disturbances, visual field defect, weakness |
| DiaBeta (DiaBeta glyburide) | No | No | Yes—feeling unsteady, weakness |
| Diabinese (chlorpropamide) | No | Yes—spinning sensation | Yes—weakness, feeling unsteady |
| Duetact (pioglitazone + glimepiride) | Yes—ear congestion | No | Yes—weakness, blurred vision |
| Farxiga (dapagliflozin) | No | No | Yes—blurred vision |
| Fiasp (aspart recombinant) | Yes—ear congestion | No | Yes—blurred vision, lightheadedness, swelling of the face |
| Fortamet Extended Release (metformin) | No | No | No |
| Gensulin NPH (isophane insulin) | No | No | No |
| Glucophage (metformin) | No | No | No |
| Glucophage XR (metformin) | No | No | No |
| Glucotrol (glipizide) | No | No | No |
| Glucotrol XL (glipizide) | No | No | No |
| Glucovance (glyburide + metformin) | No | No | Yes—blurred vision, weakness |
| Glumetza (metformin) | No | No | No |
| Glynase Press Tab (glyburide) | No | No | Yes—feeling unsteady, weakness |
| Glyset (miglitol) | No | No | No |
| Humalog (lispro U-100 and U-200) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, puffiness around the eyes, weakness |
| Iletin II NPH [NPH Iletin II] (isophane insulin) | No | No | No |
| Invokamet (canagliflozin + metformin) | No | No | Yes—weakness, lightheadedness when getting up suddenly, falls |
| Invokamet XR (canagliflozin + metformin) | No | No | Yes—weakness, lightheadedness when getting up suddenly, falls |
| Invokana (canagliflozin) | No | No | No |
| Janumet (sitagliptin + metformin) | No | No | Yes—blurred vision, weakness |
| Januvia (sitagliptin phosphate) | No | No | No |
| Jardiance (empagliflozin) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, weakness |
| Jentadueto (linagliptin + metformin) | No | No | Yes—blurred vision |
| Jentadueto XR (linagliptin + metformin) | No | No | Yes—blurred vision |
| Kazano (alogliptin + metformin) | Yes—ear congestion, pounding in the ears | No | Yes—blurred vision, weakness |
| Kombiglyze XR (saxagliptin + metformin) | Yes—ear congestion | No | Yes—blurred vision |
| Lantus (glargine) | No | No | Yes—blurred vision, weakness |
| Levemir (detemir [rDNA origin]) | No | No | No |
| Metaglip (glipizide + metformin) | Yes—pounding in the ears | No | Yes—blurred vision, dizziness, weakness |
| Micronase (glyburide) | No | No | Yes—feeling unsteady, weakness |
| Nesina (alogliptin) | Yes—ear congestion | No | Yes—blurred vision, weakness |
| Novolog (aspart) | No | No | Yes—blurred vision, lightheadedness, weakness |
| Onglyza (saxagliptin) | Yes—ear congestion | No | Yes—blurred vision, puffy or swollen eyelids |
| Orinase (tolbutamide) | No | No | Yes—weakness |
| Oseni (alogliptin + pioglitazone) | Yes—ear congestion | No | Yes—blurred vision |
| Ozempic (semaglutide) | No | No | Yes—blurred vision |
| PrandiMet (repaglinide + metformin) | Yes—ear congestion | No | Yes—blurred vision |
| Prandin (repaglinide) | No | No | No |
| Precose (acarbose) | No | No | No |
| Qtern (dapaglinide + saxagliptin) | Yes—ear congestion | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, puffiness or swelling of the eyelids or around the eyes, face |
| Regular NPH (isophane insulin) | No | No | No |
| Riomet (metformin liquid) | No | No | Yes—lightheadedness |
| SciLin NPH (isophane insulin) | No | No | No |
| Soliqua (lixisenatide/insulin glargine) | Yes—ear congestion | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, puffiness or swelling of the eyelids or around the eyes, face | |
| Starlix (nateglinide) | No | No | No |
| Steglatro (ertugliflozin) | No | No | Yes—blurred vision, lightheadedness |
| Steglujan (ertugliflozin + sitagliptin) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, sunken eyes, puffiness or swelling of the eyelids or around the eyes, face |
| Symlin (pramlintide) | No | No | Yes—blurred vision, weakness |
| Synjardy (empagliflozin + metformin) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position |
| Synjardy XR (empagliflozin + metformin) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position |
| Tanzeum (albiglutide) | Yes—ear congestion | No | Yes—blurred vision, weakness |
| Tolinase (tolazamide) | No | No | Yes—weakness |
| Toujeo NPH (insulin glargine) | No | No | Yes—blurred vision, lightheadedness, puffiness around the eyes |
| Tradjenta (linagliptin) | No | No | Yes—blurred vision, weakness, puffy or swollen eyelids |
| Tresiba (insulin degludec injection) | No | No | No |
| Trulicity (dulaglutide) | No | No | Yes—facial edema, weakness |
| Victoza (liraglutide) | Yes—ear pounding | No | Yes—weakness, blurred vision, dizziness |
| WelChol (colesevelam) | Yes—pounding in the ears | No | Yes—blurred vision, weakness |
| Xigduo XR (dapagliflozin + metformin) | No | No | Yes—blurred vision, lightheadedness when getting up suddenly from a lying or sitting position, swelling of the eyelids, face |
Not all diabetic patients taking medications for diabetes will experience the drug manufacturer's reported side effects. The list in Appendix A has been assembled as a guide for the practitioner especially when audiometric/balance assessment test results are discrepant. Professionals and PWD should consult the prescribing physician or pharmacist for additional information especially when establishing timelines from when the drug was introduced or the dosage changed.
Several medication side effects list “lightheaded when getting up suddenly from a lying or sitting position” or “unsteadiness.” Unsteadiness upon rising should most often be associated with orthostatic hypotension which can certainly be a medication side effect.
Personal communication, Richard Roberts, PhD, Department of Hearing and Speech Sciences, Vanderbilt Bill Wilkerson Center, Vanderbilt University School of Medicine, Nashville, TN.
Personal communication, Richard Gans, PhD, Director, American Institute of Balance, Largo, FL.
Prevalence of Auditory-Related Diabetes Drug Side Effects
None of the medications approved by the U.S. FDA for diabetes management and identified in this article have hearing loss or other eighth nerve pathology as a reported side effect. If hearing loss is present, it is possible, if not more than likely, that the hearing loss is from the disease, not from the medication. Table 2 shows that ear congestion and ear pounding (pulsatile tinnitus) are the most often reported auditory side effects of diabetes medications (see next section).
Table 2. Auditory Side Effects of Diabetes Medications ( n = 75) .
| Side effect | No. of drugs | Percentage |
|---|---|---|
| Ear congestion | 16 | 21.3% |
| Ear pounding | 5 | 6.6% |
| Tingling of the ears | 1 | 1.3% |
| Tinnitus | 0 | 0.0% |
Botelho et al 6 identified a 32% prevalence of hearing loss in Type 1 diabetes patients. The losses were usually sensorineural. 7 T2DM presents a much higher prevalence (up to 69%). 8 The most significant finding was that 55% of persons under the age of 60 years in the study who presented with unexplained high frequency sensorineural hearing loss were diabetic than the non-diabetic group (9%). 9
A 2018 South African study 9 aimed to determine prevalence and to characterize the nature of hearing loss in patients with diabetes in South Africa. Findings of this study showed that participants who were diagnosed with diabetes had a higher proportion of disabling hearing loss when compared to those without diabetes. Pure tone audiometry findings showed a significantly higher prevalence of hearing loss in those with diabetes (55%) when compared to those without (20%) diabetes. Further, in patients with diabetes (and diagnosed with hearing loss), the majority (74%) presented with sensorineural hearing loss.
Therefore, because hearing loss is more common in adults with diabetes as those who do not have diabetes, the professionals managing the PWD must be aware that the patient’s diabetes medication might have either an auditory and/or vestibular related side effect.
Prevalence of Tinnitus as a Diabetes Drug Side Effect
Tinnitus has multiple definitions. The most common definition in the literature is “any unwanted sound perception in the ears.” Tinnitus could occur when there is damage or a disruption in the normal motility of the outer hair cells in the cochlea, 10 associated with the presence of a pharmaceutical or from diabetes.
Kircher, et al 11 report that less than 10% of tinnitus patients report the noise as “pulsing.” This pulsing description suggests either a vascular-related etiology or a more intense perception of normal blood flow sounds in the cochlea.
During clinical trials, tinnitus can be reported (and described) as ringing, hissing, humming, buzzing, throbbing, or pounding sounds to name a few; however, none of the 75 FDA-approved medications for diabetes management have ringing, hissing, humming, buzzing, or other descriptors as a reported side effect. Five drugs (6.66%) report ear pounding as a side effect. Although there are no side effects of diabetes medications that have tinnitus as a reported side effect, a PWD who is reporting tinnitus should be referred to an audiologist for a tinnitus evaluation.
Prevalence of Ear Congestion as a Diabetes Drug Side Effect
Of all FDA-approved drugs for diabetes management, 21% of the medications listed in Appendix A have ear congestion as a reported side effect. Although this does not fit under the definition of hearing loss or tinnitus, it represents one-fifth of the medications approved for diabetes. Ear congestion may be indicative of possible Eustachian tube dysfunction creating abnormal pressure changes in the middle ear space. Again, an evaluation by an audiologist and otolaryngologist would be warranted to identify the status of the middle ear.
Vertigo/Dizziness as a Reported Side Effect
Elderly patients are at risk for falls due to changes in sensory modalities. Adding the diagnosis of diabetes and medication management with a drug that has a side effect that could mimic a vestibular issue increases the chances of injury from a fall (see the article by Piker and Romero in this issue).
Because diabetes affects three sensory modalities (balance, vision/vestibular, and somatosensory), the professionals managing the PWD must be aware that the patient's medication for diabetes management might have a vestibular side effect. Benign paroxysmal positional vertigo is twice as prevalent in PWD. 12
True vertigo (spinning) is a vestibular-related problem, but dizziness is not. Table 3 lists the diabetes medications with a vestibular-related ADR. Dizziness can be caused by many nonvestibular problems. Table 4 lists the diabetes medications with dizziness or falls as an ADR. For the PWD, presence of dizziness should be evaluated as a consequence of hypoglycemia.
Table 3. True Vestibular-Related Side Effects of Diabetes Medications ( n = 75) .
| Side effect | No. of drugs | Percentage |
|---|---|---|
| Spinning sensation | 1 | 1.3% |
| Vertigo | 1 | 1.3% |
Table 4. Dizziness and Falls as a Side Effect of Diabetes Medications ( n = 75) .
| Side effect | No. of drugs | Percentage |
|---|---|---|
| Dizziness | 2 | 2.6% |
| Falls | 2 | 2.6% |
A PWD who is experiencing vertigo should be referred to an audiologist for a balance assessment. The audiologist will then review the patient's current drug regimen and may discover that the time line for the patient's symptoms coincides with the introduction of his or her diabetes medication.
The introduction of diabetes medications could increase the risk of falls in an elderly population already at risk for falls and fall-related complications. Table 5 shows that blurred vision is the most often reported side effect of diabetes medications (56% or 42 drugs). This is an important consideration, as this side effect can affect a balance assessment.
Table 5. Side Effects that could Interfere with a Balance Assessment ( n = 75) .
| Side effect | No. of drugs | Percentage |
|---|---|---|
| Blurred vision | 42 | 56.0% |
| Weakness | 34 | 45.3% |
| Lightheadedness (upon getting up) | 11 | 14.6% |
| Lightheadedness | 10 | 13.3% |
| Puffiness/Swelling near eyes/face | 8 | 10.6% |
| Unsteady | 4 | 5.3% |
| Vision changes | 3 | 4.0% |
| Visual disturbances | 2 | 2.6% |
| Visual field defect | 1 | 1.3% |
Summary
There are 75 drugs that are approved by the U.S. Food and Drug Administration for diabetes management. Medication management is only one part of the total management strategy. Because clinical trials for all pharmaceuticals are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with the rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice. For more information on the incidence figures for all reported side effects, the drug's manufacturer should be contacted directly. The addendums to this article serve as a guide. Not all patients will experience these side effects. Establishing symptom/dosage timelines is an important part of the history analysis.
There is an entire diabetes team of professionals each with knowledge and skills to work with the PWD and their family so that the diabetes does not interfere with their lives. These professionals include endocrinologist, primary care physician, otolaryngologist, audiologist, pharmacist, podiatrist, optometrist, dentist, and, most importantly, the diabetes educator. Probably the best source of diabetes drug information and drug–drug interactions is the pharmacist. The diabetes educator is the frontline, long-term personal care manager after the diagnosis is made. Diabetes educators are a tremendous resource when we, as the other members of the diabetes team, need additional information to help us manage the PWD. See www.diabeteseducator.org for additional information. The Centers for Disease Control and Prevention has a wealth of information about diabetes management ( www.cdc.gov/diabetes/managing/index.html ).
Conflict of Interest The authors have nothing to disclose.
The terms adverse drug reaction, adverse event and side effect will be used interchangeably in this article.
These web sites are for informational purposes and not an endorsement by the authors, editors or publisher of this document or issue.
Appendix C.
Diabetes Drug Fact Sheet “By the Numbers” 2019
0 the number of drugs with tinnitus as a reported side effect
1 the number of drugs that are inhalants
1 the number of drugs with facial edema, tingling of the ears, spinning sensation, vertigo, or visual field defect as a reported side effect
2 the number of drugs with visual disturbances as a reported side effect
5 the number of drugs with ear pounding as a reported side effect
8 the number of drugs with puffiness/swelling near the eyes or on the face as a reported side effect
10 the number of drugs with lightheadedness as a reported side effect
12 the number of drugs with lightheadedness (upon getting up) as a reported side effect
16 the number of drugs with ear congestion as a reported side effect
21 the number of drugs with an auditory-related side effect
21 the number of drugs that are a combination of two diabetes drugs
22 the number drugs that are injected
31 the number drugs that are taken orally
34 the number of drugs with weakness as a reported side effect
42 the number of drugs with blurred vision as a reported side effect
43 the number of drugs with a side effect that could influence a balance assessment
75 the number of FDA-approved drugs for diabetes
726 the approximate number of ongoing clinical trials for diabetes (as of May 16, 2019)
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