Objective To perform the auditory function screening among the pre- diabetes patients by distortion product otoacoustic emission (DPOAE) in order to determine whether there is hearing loss in the patients. Methods Forty pre- diabetes patients screened out through oral glucose tolerance test, and 40 age- and sex- matched controls with normal blood glucose were enrolled in the study. Pure tone audiometry (PTA) and DPOAE were carried out on them. Results Abnormal results of PTA were found in 17 cases of 40 pre- diabetes patients and only 3 cases of 40 controls (χ2=13.067, P<0.001). The DPOAE amplitude at each frequency was lower in the pre- diabetes patients than in the controls, and significant differences were found at the frequencies of 1.5, 2, 3, 4 and 6 kHz (P<0.05). The detection rates of abnormal results by DPOAE were obviously higher than those by PTA at the frequencies of 1, 2 and 4 kHz (P<0.001). Conclusion Pre- diabetes patients have hearing loss. DPOAE, with higher sensitivity than PTA, can detect the changes of cochlear outer hair cells earlier, and can be used as an effective and objective detection for early alterations of cochlear function in pre- diabetes patients.