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Type 2 diabetes mellitus (T2DM) has increasingly been identified as a risk factor for sensorineural hearing loss, whereas the association between different antidiabetic therapies and hearing thresholds remains poorly characterized. This retrospective observational study evaluated 240 patients with T2DM and 105 normoglycemic controls who underwent standardized pure-tone audiometry at the Audiology Section of the University of Palermo between February 2025 and January 2026. Hearing thresholds were measured using the pure tone average (PTA-mean) at 0.5, 1, 2, and 4 kHz, corresponding to speech-relevant frequencies. Multivariable analysis of covariance, adjusted for age, sex, body mass index, and smoking status, showed that subjects with T2DM had significantly higher PTA-mean values compared to controls (64.4 ± 17.1 dB vs. 56.4 ± 14.8 dB; p = 0.007), indicating worse hearing thresholds. Among specific antidiabetic treatments, GLP-1RAs, metformin, and pioglitazone were associated with lower PTA-mean values. Furthermore, pharmacological class analysis showed that GLP-1 receptor agonists and biguanides were associated with more favorable hearing thresholds. These findings suggest that antidiabetic pharmacotherapy may show class-specific associations with auditory function, supporting the need for prospective studies to evaluate whether hearing outcomes should be considered in the broader management of diabetes-related comorbidities.