title: Progression of symptoms and functioning among female cardiac patients with and without diabetes.
abstract: OBJECTIVE
  To determine if older women with both heart disease and diabetes experience worse physical and psychosocial functioning and higher symptom burden over an 18-month period compared with those with heart disease alone.
  
  
  METHODS
  Data from older women with heart disease (≥60 years, n = 1008, 18% with diabetes) were used to assess the impact of diabetes on physical functioning (Sickness Impact Profile [SIP]-Physical and Six-Minute Walk test [6MWT]), psychosocial functioning (SIP-Psychosocial and depressive symptoms), and physical symptom burden (cardiac and general) at baseline and 4, 12, and 18 months later. Generalized estimating equation models compared trends in outcomes over time between groups with and without diabetes.
  
  
  RESULTS
  Across all four time points, women with heart disease and diabetes had greater functional impairment, as indicated by higher SIP scores, than those without diabetes (43%-71% higher SIP-Physical scores and 32%-65% higher SIP-Pyschosocial scores; all p ≤ 0.002). 6MWT distance was 17%-30% less in the diabetes group across time points (all p ≤ 0.002). Depressive symptoms were 27%-39% higher in the diabetes group (all p < 0.03) except at month 4. Women with diabetes scored 15%-29% higher on a physical symptom index across time points (all p < 0.05) than those without diabetes; no significant differences were observed in cardiac symptoms until month 18 (diabetes group 29% higher, p = 0.02). Subgroups with and without diabetes in this sample experienced significantly different trends over time in SIP-Physical scores (p = 0.02) and 6MWT distance (p = 0.05), such that the disadvantage of the diabetes group at baseline was greater 18 months later.
  
  
  CONCLUSIONS
  Women with comorbid diabetes and heart disease are vulnerable to poor health-related quality of life, particularly in terms of physical functioning and symptoms, and require special efforts from clinical care providers to ameliorate a potential downward trend in these outcomes over time.
authors.affiliation: Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA. mjanevic@umich.edu
authors.forename: Mary R
authors.initials: MR
authors.lastname: Janevic
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Janz
authors.forename: Cathleen M
authors.initials: CM
authors.lastname: Connell
authors.forename: Niko
authors.initials: N
authors.lastname: Kaciroti
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000503:physiopathology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000503:physiopathology; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D006801:Humans; D016016:Proportional Hazards Models; D011610:Psychosocial Deprivation; D012720:Severity of Illness Index; D016387:Women's Health