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diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia .
several distinct types of diabetes mellitus exist and are caused by a complex interaction of genetic , environmental factors and life style choices .
type-2 diabetes is due to predominantly insulin resistance with relative insulin deficiency niddm , which is much more common than iddm was discovered by chance .
it is typically gradual in onset and occurs mainly in the middle aged and elderly .
the metabolic dysregulation associated with dm causes secondary patho - physiological changes in multiple organ systems . in general the risks of chronic complication increases as a function of the duration of hyperglycemia , they usually become apparent in the second decade of hyperglycemia . since type-2 dm often has a long asymptomatic period of hyperglycemia ,
so far most of the clinical and diagnos - tic studies on diabetic neuropathy have concerned only peripheral and autonomic nerve but recently with the refinement of evoked potential techniques detailed explora - tion of sensory pathway in central nervous system has been possible .
also pathological studies by reske - nielson and ludback ( 1965 ) and makishima and tanaka ( 1971 ) have shown involvement of brain parenchyma in patients of long standing dm .
the brainstem auditory electric responses represent a useful , non invasive and simple procedure to detect both acoustic nerve and cns damage .
abr is a far field recording of the synchronized response of a large number of neurons in the lower portion of auditory pathway .
it was first described by shemer and femmesser in 1967.a full description of aep is given by hyde ( 1987 ) . at present this evoked potential has become a routine part of the standard audio logical test battery .
it is recorded by placing active electrodes positioned at vertex and reference electrode at the mastoid or earlobe .
wave i and ii represent activity in cochlear nerve , wave iii in cochlear nucleus , wave iv in superior olivary complex , wave v which is biggest and most consistent represent activity in nuclei of lateral lemniscus while wave vi and vii in the inferior colhculus . in this way
the amplitude of peaks are variable with in subjects while the latencies of peaks are stable and are well documented . in detecting evidence of central neuropathy in dm , coshum durmus et al ( 2004 ) , toth et al(2001 ) , virtamemi
j et al(1993 ) found evidence of central auditory pathway involvements . a very distinct advantage of using abr as a diagnostic modality that it is resistant to the effect of sleep , sedation and anesthesia .
it is suitable for children and for adult who are not able to co - operate .
the present study was carried at finding out central auditory pathway involvement in diabetes mellitus by bera .
the study was carried out in the department of ent , jnmc from 2008 -2010 .
the study included two groups , ( i ) diabetic group ( n=25 ) ( ii ) control group ( n=25 ) .
exclusion criteria : patient who gave history of ear disease , exposure to prolonged loud noise , intake of ototoxic drug , stroke , head injury or family history of deafness were not included .
patient taking any medication which might be expected to interfere with the functioning of central nervous system .
( methyldopa , reserpine , phenytoin , antipsychotic , antidepressants ) were excluded from the study .
in the control group 17 ( 68% ) were males where as 8 ( 32% ) were females . mean age of control group was 45.7 years . in the study group 13 ( 52% )
camparison of absolute latencies and interpeak latencies in controls and in patients with diabetes mellitus at 70 , 80 and 90 db significant difference was found in latencies of wave iii and interpeak iii - v while highly significant difference was found in latencies of wave v and interpeak i - iii , i - v between control and study groupat70db .
highly significant difference was found in latencies of wave iii , v and interpeak i - iii and i - v while significant difference was found in interwave iii - v between control and study group at 80 db .
significant difference was found in latencies of wave v and interpeak iii - v while highly significant difference was found in wave iii and interpeak i - iii , i - v between control and studygroupat90db .
the duration of dm was 5 - 10 years in 13 ( 52% ) patients and among these patients bera was delayed in 7 ( 53.84% ) subjects .
12 ( 48% ) patients had history of diabetes for > 10 years and among these patients , bera was delayed in ( 91.66% ) subjects . in the study group
13/25 cases had neuropathy , 1/25 cases had nephropathy and 2/25 cases had retinopathy in the study group among 25 patients , 13 ( 52% ) patients had peripheral neuropathy and the bera was delayed in 12(92.3% ) patients . while the incidence of delayed bera was 50% in patients without peripheral neuropathy .
both the study group and control group were tested 2 - 3 times , so as to confirm the reproducibility of the results .
the recordings were tabulated and statistical analysis of the data was done by applying  unpaired student 's t - test  to the data . a p - value of less than 0.05 and less than < 0.001 was considered as significant and highly significant respectively .
the maximum number of cases i.e. , 11 ( 44% ) were from 41 - 50years age group . the mean age of study group was 46.8years and mean age of controls was 45.5years .
the latency of wave i was found to be equal in the diabetics and controls .
this suggests that the eight nerve transmission till the level of cochlear nucleus was not altered in the diabetics .
the latency of wave iii was delayed by 0.39 msec , 0.42 msec and 0.42 msec at 70 , 80 and 90 db respec - tively in diabetic group as compared to control group .
the latency of wave v was delayed by 0.48 msec , 0.47 msec and 0.50 msec at 70 , 80 and 90 db respectively in diabetic group as compared to control group .
the interpeak latency i - iii , iii - v and i - v was delayed in the diabetic group .
this suggests delayed transmission of the auditory stimulus in the auditory pathway of diabetics at the level of brainstem and midbrain .
the delay in the latency of wave iii and v in the diabetics indicate neuropathy at brainstem and midbrain level in the auditory pathway .
fidele et al in 1984 found the latencies ( ms ) of abr waves were significantly impaired in diabetic subjects as compared with normal . peripheral transmission time ( wave i ) and central transmission time ( wave i - v )
kunen et al in 1989 evaluated hearing threshold of 30 diabetic patients and 30 healthy controls by using puretone audiometry .
all age group with diabetes showed a significant high frequency hearing loss as compared to the control population .
sharma et al in ( 2000 ) found the incidence of delayed wave latencies in diabetics was 64% , 72% and 84% at 2 khz , 4 khz and 6 khz respectively , suggesting that if brainstem evoked response audiometry is conducted at higher fre - quency like 6 khz in diabetic patients , and the involvement of central neural axis can be detected earlier .
diabetes for more than 10 years duration was present in 12 ( 48% ) patients , among these bera was delayed in 11 ( 91.66% ) cases .
so longer duration of diabetes is a definite risk factor for development of central neuropathy .
diabetics with peripheral neuropathy ( n= 13 ) had more incidence of delayed bera ( n=12 ) tracings .
so we concluded that diabetic subjects could suffer not only from peripheral and autonomic neuropathy but also from central neuropathy .
bayazit y et al in 2000 also concluded the likelihood of encountering a diabetic complication increases as the abr results become abnormal .
bera is a simple , non - invasive procedure to detect early impairment of acoustic nerve , and cns pathways , even m the absence of specific symptoms .
this study suggests that if bera is carried out in diabetic patients ; involvement of central neuronal axis can be detected earlier .
so we strongly recommend that bera should be done in all patients with diabetic mellitus .
introduction : diabetes mellitus comprises a group of common metabolic disorders that share the phenotype of hyperglycemia . the metabolic dysregulation associated with dm causes secondary patho - physiological changes in multiple organ systems . 
 the brainstem auditory electric responses represent a useful , non invasive and simple procedure to detect both acoustic nerve and cns damage.material & methods : the study was carried out in the department of ent , jnmc from 2008 -2010 . 
 the study included two groups , ( i ) diabetic group ( n=25 ) ( ii ) control group ( n = 25 ) . 
 diabetic group included patients attending endocrinology opd and ward . 
 the equipment used for recording evoked response audiometry is ihs - bera . 
 model number th72312ht . 
 year of manufacture 2006.results:mean age of control group was 45.7 years . in the study group 13 ( 52% ) were males where as 12 ( 48% ) were females . 
 mean age of study group was 46.8 years . 
 there is no significant difference between age groups of controls and cases . 
 significant difference was found in latencies of wave iii and interpeak iii - v while highly significant difference was found in latencies of wave v and interpeak i - iii , i - v between control and study group at 70 db . 
 highly significant difference was found in latencies of wave iii , v and interpeak i - iii and i - v while significant difference was found in interwave iii - v between control and study group at 80 db . 
 significant difference was found in latencies of wave v and interpeak iii - v while highly significant difference was found in wave iii and interpeak i - iii , i - v between control and study group at 90 db.conclusion:bera is a simple , non - invasive procedure to detect early impairment of acoustic nerve , and cns pathways , even in the absence of specific symptoms . 
 this study suggests that if bera is carried out in diabetic patients ; involvement of central neuronal axis can be detected earlier .