Aim: To evaluate the progression of hearing loss in patients with diabetes mellitus (DM) and identify the role of glycemic control, diabetes duration, and microvascular complications as contributing factors. Materials and Methods: This prospective cohort study included 100 patients aged 18–70 years with type 1 or type 2 DM, recruited based on specific inclusion and exclusion criteria. Comprehensive medical, audiological, and diabetic assessments were conducted at baseline, followed by audiometric testing at 6 and 12 months. Hearing thresholds were measured using pure-tone audiometry (PTA) across multiple frequencies. Glycemic control was classified as good (HbA1c ≤7%) or poor (HbA1c >7%). Statistical analyses, including t-tests, chi-square tests, and logistic regression, were performed to identify significant predictors of hearing loss progression. Results: At baseline, patients with poor glycemic control demonstrated significantly worse hearing thresholds across all frequencies compared to those with good control (p<0.05). Over 12 months, hearing thresholds worsened significantly, with a mean increase from 21.4 dB (±7.3) to 26.8 dB (±9.2, p<0.01). Logistic regression identified poor glycemic control (OR: 2.8, p<0.001), longer diabetes duration (OR: 1.2, p=0.002), retinopathy (OR: 1.9, p=0.03), and neuropathy (OR: 2.1, p=0.01) as significant predictors of hearing loss progression. Conclusion: Hearing loss progression in diabetic patients is strongly influenced by glycemic control, diabetes duration, and microvascular complications. These findings emphasize the need for routine audiological assessments and stringent glycemic management to mitigate hearing loss progression and improve quality of life.