Journal Club presentation - Cross sectional study.pdf

The presentation focuses on a Journal Club presentation -a cross sectional l study, and I've included a comprehensive critical appraisal utilizing the AXIS protocol for thorough analysis.I've aimed to provide a thorough examination of the study's methodology, findings, and potential implications, in line with our objectives for the Journal Club session.

1. JOURNAL CLUB PRESENTATION
Presented By Dr. Monisha Mary P

2. 28-Apr-24 2
TITLE OF THE
ARTICLE
Assessment of risk of type
2 diabetes using simplified
Indian Diabetes Risk
Score – Community-based
cross-sectional study

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INFORMATION ON THE JOURNAL
Journal name - International Journal of Medical Science and
Public Health Online.
Open access article
Indexing - Indian Science Abstracts, Open J Gate, Index
Copernicus, HINARI, Google Scholar, Scopemed,IndexMedicus
Impact factor - 3.642

4. 28-Apr-24 4
Received - May 16, 2016 Accepted - June 1, 2016
Volume - Vol 5 | Issue 12
DOI - 10.5455/ ijmsph.2016.16052016517
Keywords - Simplified Indian Diabetes Risk Score, Abdominal
obesity, Physical activity, Family history of diabetes.

INFORMATION ON THE ARTICLE

5. Krutarth R Brahmbhatt
Tamal Chakraborty
Chandana Gopal
Shwethashree M
Sajjan Madappady
Sowndarya TA
Bharani Kumar Anbalagan
28-Apr-24 5
INFORMATION ON THE AUTHORS
Department of Community Medicine, A.J.
Institute of Medical Sciences & Research
Center, Mangalore, Karnataka, India.
Department of Community Medicine, GMERS
Medical College, Junagadh, Gujarat, India.

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SELECTED ARTICLE FOR PRESENTATION
CROSS
SECTIONAL
STUDY
DIABETES
MELLITUS
STUDY
CONDUCTED IN
KARNATAKA

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CONTENTS

❖BACKGROUND
❖THE ARTICLE PRESENTATION
❖CRITICAL APPRAISAL

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International Diabetes Federation IDF

9. Family history
Abdominal
obesity
Age
IDRS
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9
VARIABLES USED IN IDRS
Physical
activity

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❖Simplified Indian Diabetes Risk Score (IDRS).
❖IDRS has been validated by various studies conducted in
different parts of India. (3-6)
IDRS is useful for
•Undiagnosed diabetic subjects
•Cost-effective
•Effective tool for mass screening.
IDRS

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11
Optimum
sensitivity
Optimum
specificity
High
positive
predictive
value
High
negative
predictive
value
IDRS

12. PREVALENCE OF DM IN INDIA
13.5%
CHENNAI
12.4%
BANGALORE
16.6%
HYDERABAD
11.6%
NEW DELHI
11.7%
KOLKATTA
MUMBAI 9.3%
Prevalence in the southern part of India is higher
Source- National Urban DiabetesSurvey (NUDS)

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INTRODUCTION
As the
prevalence of
diabetes
mellitus is
higher in South
India.
The majority
of the
subjects
remain
undiagnosed
for diabetes.
The study
was
conducted to
find out the
high-risk
people for
diabetes.

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02

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OBJECTIVES
To assess risk for type 2
diabetes amongst study
participants using simplified
version of Indian diabetes risk
score.
To estimate the prevalence of
abdominal obesity and physical
activity among males and
females.
To find out proportion of
positive family history for
diabetes in study participants.
To study association of socio-
demographic variables with
diabetes.

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03METHODOLOGY

17. Study Design - A community-based cross-sectional study.
Study setting - Urban field practice area of the institute.
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STUDY DESIGN AND PARTICIPANTS

18. STUDY DURATION
JulJan
l
Aug
Sep Nov
Oct DecFeb
Mar Apr May Jun
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JANUARY TO APRIL
2015
YEAR 2015

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•With reference to the study conducted by Ramachandran A,
et al, in India titled “High Prevalence of Diabetes and
impaired glucose tolerance in India: National Urban Diabetes
Survey (7).
•Sample size was derived by formula: 4 pq/L2,
where p = 10%,
q = 90%,
Absolute precision: 5%
=144.
SAMPLE SIZE CALCULATION

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The minimum sample size for the study was concluded to be
144

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SAMPLING METHOD
Was used to select the
participants from the registers
available at UHC.

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INCLUSION CRITERIA
Selected participants aged 20 years and above, not
diagnosed cases of diabetes were included in the study.
Written informed consent was obtained from
all the participants.

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EXCLUSION CRITERIA
If the particular participant was not available at the time
of the visit, a second visit was done the very next day.
If the person was not available after two visits one more
participant was selected randomly from the list.

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STUDY TOOL
PART A PART B
Sociodemographic
Information
Simplified Diabetes
Risk Score

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• Questionnaire was validated for use in local language
➢ Translation from English to Kannada
➢ And back translation from Kannada to English.
STUDY TOOL

26. Approved by the
Institutional Ethics
Committee
Visiting the houses of
the selected
participants.
Obtained from
all participants
APPROVAL
INFORMATION
SHEETS
Explained to all the
participants
WRITTEN INFORMED
CONSENT
METHOD OF DATA COLLECTION
DATA
COLLECTION
Data was collected by post-graduate students by interview method in the local language

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OPERATIONAL DEFINITIONS

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29. PARTICIPANTS
WITH IDRS
≥60
30- <60
<60
I
D
R
S
HIGH RISK INTERMEDIATE RISK LOW RISK FOR DIABETES MELLITUS
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29

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OPERATIONAL DEFINITIONS
Family history of diabetes- If either or both of a participant’s
parents had diabetes, they were considered to have a
positive family history.
Physical activity- Grading was done as per WHO STEPS
definitions of
•sedentary
•mild
•moderate
•or vigorous physically active.

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OPERATIONAL DEFINITIONS
Abdominal obesity-
•Waist circumference (cm) was measured using a non-
stretchable measuring tape.
•Waist circumference was measured at the smallest
horizontal girth between the costal margins and the iliac
crest at the end of expiration.
•Abdominal obesity (AO) was defined as a waist
circumference (WC) ≥ 90 cm for men and ≥ 80 cm for
women.

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STATISTICAL ANALYSIS
Data were entered
into Microsoft excel
sheet and analysed
using SPSS version
17.0 software.
Frequency,and
percentages
(descriptive statistics)
were calculated.
Pearson’s Chi-square
was used as a test of
significance. P-value <
0.05 was considered
statistically significant.

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04RESULTS

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RESULTS
In total, 145 persons participated in the
study. Sociodemographic profile of
participants is described in Table 1.
Assessment results for all the parameters of
“Simplified Indian Diabetes Risk Score” are
mentioned in Table 2.
Association of gender with IDRS parameters
is described in Table 3.

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DISCUSSION

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THE PREVALENCE OF PEOPLE AT HIGH RISK
OF DIABETES WAS 34%
THE PREVALENCE
OF ABDOMINAL
OBESITY
THE PREVALENCE
OF PHYSICAL
ACTIVITY
THE PREVALENCE OF
POSITIVE FAMILY
HISTORY
MALES
44%
FEMALES
84%
MALES
64%
FEMALES
49%
IN EITHER
PARENT
22%
BOTH
PARENT
22%

42. THE PREVALENCE OF PEOPLE AT
HIGH RISK OF DIABETES WAS 34%.
01 02 03 04
URBAN AREA
OF
PUDUCHERRY
31%
URBAN SLUM OF
PUNE,
MAHARASHTRA
37%
URBAN
AREA OF
JAMNAGAR,
GUJARAT
29%
MEDICAL
OPDS OF A
MEDICAL
COLLEGE
HOSPITAL
25%
THE PREVALENCE OF DIABETES IS HIGHER IN SOUTH INDIA THAN OTHER PARTS OF THE
COUNTRY.

43. THE PREVALENCE OF ABDOMINAL OBESITY WAS 44% AND 84%
AMONG MALES AND FEMALES
01 02
NORTH INDIA USING
THE SAME CUT-OFF
VALUES OF 62% AND
75% AMONG MALES
AND FEMALES
SOUTH INDIA 31% AND
66% AMONG MALES
AND FEMALES

44. PREVALENCE OF PHYSICAL ACTIVITY AMONG MALES AND
FEMALES WAS 64% AND 49%
01 02
ICMR REPORTED
PHYSICAL
ACTIVITYIN
MALES AND
FEMALES AS 60%
AND 40%
AHMEDABAD, GUJARAT
PHYSICAL ACTIVITY IN
MALES AND FEMALES
UP TO 68% AND 32%,

45. PREVALENCE OF POSITIVE FAMILY HISTORY (IN EITHER PARENT
OR BOTH PARENTS) WAS 22%
01 02
PUNE,
MAHARASHTRA
REPORTED IT AS 23%
URBAN AREA
JAMNAGAR, GUJARAT
PREVALENCE OF
POSITIVE FAMILY
HISTORY OF DIABETES
UP TO 18%

46. STRENGTH OF THE STUDY
A COMMUNITY -BASED STUDY
A VALIDATED QUESTIONNAIRE
(IDRS) WAS USED.

47. LIMITATIONS
RECALL BIAS MIGHT HAVE
PLAYED ROLE IN
REPORTING OF FAMILY
HISTORY BY PARTICIPANTS.

48. CONCLUSIONS
❖ One-third of the participants were at
high risk for diabetes.
❖ IDRS is a simple and easy-to-use tool
to assess the risk of diabetes in the
community.
❖ It should be used routinely in
community-based screening to find out
high risk people for diabetes.

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REFERENCE
1.http://www.idf.org/membership/sea/india (last accessed on December 5,
2015).
2. Mohan V, Deepa R, Deepa M, Somannavar S, Datta M. A simplified Indian
diabetes risk score for screening for undiagnosed diabetic subjects. J Assoc
Physicians India 2005;53:759–63.
3. Chaurasia H, Chaurasia RS. To find out the diabetic risk in study population by
subjecting them to Indian diabetic risk scale. Int J Med Sci Res Pract
2015;2(1):37–40.
4. Taksande B, Ambade M, Joshi R. External validation of Indian diabetes risk
score in a rural community of central India. J Diabet Mellitus 2012;2:109–13.

50. 28-Apr-24 50
5. Patel DN, Shah MC, Ahir GN, Amin DV, Singh MP. A study on validity of
Indian diabetes risk score (MDRF) for screening of diabetes mellitus among the
high risk group (policemen) of diabetes mellitus of Bhavnagar city. Innovative J
Med Health Sci 2012;2:109–11.
6. Adhikari P, Pathak R, Kotian S. Validation of the MDRF-Indian Diabetes Risk
Score (IDRS) in another south Indian population through the Boloor Diabetes
Study (BDS). J Assoc Physicians India 2010;58:434–6.
7. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, et al.
Diabetes Epidemiology Study Group in India (DESI). High prevalence of
diabetes and impaired glucose tolerance in India: National Urban Diabetes
Survey. Diabetologia 2001;44:1094–101

51. 28-Apr-24 51
8. Shah B. Development of Sentinel Health Monitoring Centers for Surveillance of
Risk Factors of Non-communicable Diseases in India (April 2003 to March 2005).
Collated Results of Six Centers. New Delhi: Division of Non-communicable
Diseases, Indian Council of Medical Research, 2005. Available at: http://
www.who.int/chp/steps/IndiaSTEPSReport_6Centers.pdf (last accessed on March
10, 2016).
9. Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et al.
Prevalence of generalized & abdominal obesity in urban & rural India – the ICMR –
INDIAB Study (Phase-I) [ICMR – INDIAB-3]. Indian J Med Res 2015;142(2):139–
50.

10. Gupta SK, Singh Z, Purty AJ, Vishwanathan M. Diabetes prevalence and its
risk factors in urban Pondicherry. Int J Diabet Dev Ctries 2009;29(4):166–9.

52. 28-Apr-24 52
11. Patil RS, Gothankar JS. Assessment of risk of type 2 diabetes using the
Indian Diabetes Risk Score in an urban slum of Pune, Maharashtra, India: A
cross-sectional study. WHO South-East Asia J Public Health 2016;5(1):53–
61.
12. Khandhedia SA, Chaudhary AI, Unadkat S, Parmar D. A study on
assessment of risk of developing diabetes using IDRS (Indian Diabetes Risk
Score) in the urban area of Jamnagar city. Sch J Appl Med Sci
2015;3(6C):2358–60.
13. Bhardwaj S, Misra A, Misra R, Goel K, Bhatt SP, Rastogi K, et al. High
prevalence of abdominal, intra-abdominal and subcutaneous adiposity and
clustering of risk factors among urban Asian Indians in North India. PLoS
ONE 2011;6(9):e24362. doi:10.1371/journal.pone.0024362.

53. 28-Apr-24 53
14. Chauhan RC, Chauhan NS, Mani Kandan, Purty AJ, Mishra AK, Singh Z.
Obesity among adult population of a rural coastal area in South India. Int J
Sci Rep 2015;1(3):155–8.
15. Anjana RM, Pradeepa R, Das AK, Deepa M, Bhansali A, Joshi SR, et al.
Physical activity and inactivity patterns in India– Results from the ICMR-
INDIAB study (Phase-1) [ICMRINDIAB-5]. Int J Behav Nutr Phys Activ
2014;11:26.
16. Nayak H, Gadhavi R, Vyas S, Kapoor R, Brahmbhatt K. Epidemiological
determinants of the physical activity among the urban community of
Ahmedabad, India: A cross sectional study. GJMEDPH 2013;2(6):1–6.

54. CRITICAL APPRAISAL
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54
Appraisal tool for Cross-Sectional Studies (AXIS)

55. WERE THE AIMS AND OBJECTIVES OF THE
STUDY CLEAR
4 objectives.
The purpose of the study is clearly stated.
The aim is stated both at the beginning of the
abstract and at the end of the introduction.
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55

56. WAS THE STUDY DESIGN APPROPRIATE FOR
THE STATED AIMS
STUDY DESIGN -Assessment of risk of type 2
diabetes/cross-sectional study
STUDY SETTING -The relevant information on the
location is present.

STUDY DURATION-The period of recruitment is
mentioned.
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56

57. WAS THE SAMPLE SIZE JUSTIFIED
The reference article has been mentioned.

Sample size was derived by formula: 4 pq/L
2

where p = 10%, q = 90%, absolute precision:
5%, = 144.
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57

58. WAS THE INCLUSION/EXCLUSION CRITERIA
MENTIONED
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59
The inclusion and exclusion criteria have been
given.

59. WAS THE TARGET/REFERENCE POPULATION
CLEARLY DEFINED
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60
The target population is not mentioned

60. WAS THE SAMPLE FRAME TAKEN FROM AN
APPROPRIATE POPULATION BASE
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61
Participants were taken from the registers
available at UHC.

61. WAS THE SELECTION PROCESS LIKELY TO
SELECT SUBJECTS/PARTICIPANTS THAT WERE
REPRESENTATIVES OF THE TARGET POPULATION
UNDER INVESTIGATION
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Yes, Simple random sampling.
Participants were taken from the registers
available at UHC.

62. WERE MEASURES UNDERTAKEN TO ADDRESS
AND CATEGORISE NON RESPONDERS
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63
Yes , mentioned in the exclusion criteria .
If the person was not available after two visits
one more participant was selected randomly
from the list.

63. WERE THE RISK FACTOR AND OUTCOME
VARIABLES MEASURED APPROPRIATE TO THE
STUDY
The study estimates the prevalence of abdominal
obesity and physical activityamong males and
females.
They have found out the proportion of positive
family history for diabetes in study participants.
They have not studied the association of certain
socio-demographic variables with diabetes.
28-Apr-24
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64

64. WERE THE RISK FACTOR AND OUTCOME
VARIABLES MEASURED CORRECTLY USING
INSTRUMENTS/MEASUREMENTS THAT HAD BEEN
TRIALED,PILOTED, OR PUBLISHED PREVIOUSLY
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65
WHO step guidelines for NCD have been
used.
IDRS tool.

65. IS IT CLEAR WHAT WAS USED TO DETERMINE
STATISTICAL SIGNIFICANCE ?
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66
Software package – SPSS version 17.

The statistical significance levels are clearly stated.

66. WERE THE METHODS (INCLUDING STATISTICAL
METHODS) SUFFICIENTLY DESCRIBED TO
ENABLE THEM TO BE REPEATED? )
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67
Frequency and percentages (descriptive
statistics) were calculated.
Pearson’s Chi-square was used as a test of
significance. P-value < 0.05 was considered
statistically significant.

67. WERE THE BASIC DATA ADEQUATELY
DESCRIBED?
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68
Basic data is mentioned .
But the description is limited.

68. DOES THE RESPONSE RATE RAISE CONCERNS
ABOUT NON-RESPONSE BIAS?, IF APPROPRIATE
INFORMATION ABOUT NON -RESPONDERS
DESCRIBED?
.
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69
Not mentioned and not described
There has been no attempt made to quantify
the level of non-response by the researchers.

69. WERE THE RESULTS INTERNALLY
CONSISTENT?
.
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70
The study recruited 145 participants.
The tables and the text included data from about
145 participants.

70. WERE THE RESULTS FOR THE ANALYSES
DESCRIBED IN THE METHODS, PRESENTED?
.
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71
The results have been described in the
methodology.
The results from all analyses are described.

71. WERE THE AUTHORS’ DISCUSSIONS AND
CONCLUSIONS JUSTIFIED BY THE RESULTS?
.
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72
The study summarised the key results of the study
objectives.
Overall interpretation of the results.
Addressed both significant and nonsignificant
findings.
Made comparisons with other research, citing
their sources.

72. WERE THE LIMITATIONS OF THE STUDY
DISCUSSED?
.
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73
Anunderstandingof the limitations has been
involved in the study.
Recall bias – family history.

73. WERE THERE ANY FUNDING SOURCES OR
CONFLICTS OF INTEREST THAT MAY AFFECT THE
AUTHORS’ INTERPRETATION OF THE RESULTS?
.
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None declared.

74. WAS ETHICAL APPROVAL OR CONSENT OF
PARTICIPANTS ATTAINED?
.
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75
Ethical committee clearance was
obtained.
Written consent was taken from the
participants of the study.

75. WAS THE REFERENCE OF THE STUDY
APPROPRIATE?
.
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76
Author
/Organisation
Title of
webpage
[Internet]
Place of
publication:
Publisher
Webpage
Year of original
publication OR
Year of Copyright
1.http://www.idf.org/membership/sea/india (last
accessed on December 5, 2015).
Last accessed
16 REFERENCES

76. Thank you