Center for Managing Chronic Disease, University of Michigan School of Public Health, Ann Arbor, MI 48109-2029, USA.
J Womens Health (Larchmt). 2011 Jan;20(1):107-15. doi: 10.1089/jwh.2010.2123. Epub 2010 Nov 22.
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.
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.
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.
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.
确定患有心脏病和糖尿病的老年女性在 18 个月内的身体和心理社会功能以及更高的症状负担是否比仅患有心脏病的女性更差。
使用患有心脏病（≥60 岁，n=1008，18%患有糖尿病）的老年女性的数据，评估糖尿病对身体功能（疾病影响概况[SIP]-身体和六分钟步行测试[6MWT]）、心理社会功能（SIP-心理社会和抑郁症状）以及身体症状负担（心脏和一般）的影响。在基线和 4、12 和 18 个月后。广义估计方程模型比较了有和没有糖尿病的组之间随时间变化的趋势。
在所有四个时间点，患有心脏病和糖尿病的女性的功能障碍比没有糖尿病的女性更严重，这表明 SIP 评分更高（SIP-Physical 评分高 43%-71%，SIP-Pyschosocial 评分高 32%-65%；所有 p 值均≤0.002）。在整个时间段内，糖尿病组的 6MWT 距离降低了 17%-30%（所有 p 值均≤0.002）。糖尿病组的抑郁症状高 27%-39%（所有 p 值均<0.03），除了在第 4 个月。在整个时间段内，患有糖尿病的女性的身体症状指数高 15%-29%（所有 p 值均<0.05），而没有糖尿病的女性则没有明显差异；直到第 18 个月才观察到心脏症状的差异（糖尿病组高 29%，p=0.02）。在 SIP-Physical 评分（p=0.02）和 6MWT 距离（p=0.05）方面，样本中的有和无糖尿病亚组随时间的趋势明显不同，因此糖尿病组在基线时的劣势在 18 个月后更大。
患有合并糖尿病和心脏病的女性易受到健康相关生活质量下降的影响，尤其是在身体功能和症状方面，临床护理提供者需要特别努力，以缓解这些结果随时间的潜在下降趋势。
