Citation:Body Mass Index and Mortality among Adults with Incident Type 2 Diabetes

Are the results valid?

1. Was there a clearly defined, focused research question? What was the study question? Ya, Pertanyaan Penelitian nya adalah apakah ada hubungan angka kematian dengan BMI pada pasien dengan diabetes melitus tipe 2

2. How was the exposed cohort selected? Was there a well defined selection procedure for inclusion into the cohort? What proportion of eligible subjects was actually included?Peserta yang masuk dalam penelitian ini adalah, pasien yang terdiagnosis DM tipe 2 tanpa ada penyakit penyulit lain seperti penyakit kardiovaskuler dan kanker. Kelompok terpapar adalah kelompok yang dibedakan dengan melihat ada riwayat merokok dan melihat umur saat diagnosis

3. How was the non-exposed cohort selected? Was this cohort drawn from the same source population as the exposed cohort? Was there a well defined selection procedure for inclusion into the cohort? What proportion of eligible subjects was actually included?Kelompok yang tidak terpapar, diambil dari peserta yang di diagnosis DM tetapi tidak merokok

4. How were the main exposures ascertained? Were the exposures clear, specific and measurable? Any likelihood of exposure misclassification?Semua pasien sama terdiagnosis diabetes melitus akan tetapi yang membedakan hanya riwayat (merokok, jenis kelamin, dll.)

5. Was the cohort free of the disease (outcome) at the start of follow-up? Were only people at risk of the outcome included?Peserta yang dipilih adalah pasien yang mempunyai resiko untuk terkena diabetes melitus tipe 2

6. Was duration of follow-up adequate (i.e. long enough for main outcomes to occur)?Ya, jangka waktu follow up cukup lama untuk menilai dan mengetahui primary outcome

7. Was follow-up complete? Were efforts Ya, Follow up dilakukan hingga peserta meninggal

CRITICAL APPRAISAL OF A COHORT STUDYCOHORT WORKSHEETName: Viko Bagus LisephanoDate: 25 Juni 2015

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made to limit the loss to follow-up? What was the rate of attrition and was loss to follow-up similar in the exposed and non exposed cohorts?Atau hingga batas waktu penelitian berakhir yaitu 1 januari 2012

8. What were the primary and secondary outcomes of the study? How well were the outcomes measured? Was the outcome clear, specific and measurable? Were surrogate outcomes used?Primari outcome nya adalah menghitung jumlah kematian oleh penyebab apapun pada peserta dengan diabetes tipe 2.

Secondary outcome nya adalah untuk mencari penyebab tersering kematian yabg terjadi.

9. Were outcomes measures similarly in exposed and non exposed cohorts? Was outcome ascertainment influenced by knowledge of the exposure status (i.e. lack of blinding)?Metode pengukuran sama berdasarkan BMI dan riwayat lifestyle seperti merokok

10. How comparable were the exposed and non-exposed cohorts? Have the authors identified all potentially important confounders? Is there information on how the potential confounders are distributed between the comparison groups? What confounders were adjusted for and was the adjustment adequate? Is residual confounding a concern?

What are the results?

What are the study results?

1. How strong was the association between exposure and outcome (e.g. rate ratio or hazard ratio or odds ratio)?Terdapat 3083 kematian pada periode 15.8 tahun follow up. Asosiasi J-Shaped melakukan observasi pada kategori BMI (18.5 sampai 22.4, 22.5 sampai 24.9, 25.0 sampai 27.4, 27.5 sampai 29.9, 30.0 sampai 34.9 dan lebih dari 35.0) untuk semua penyebab kematian (Hazard ratio, 1.29 [95 Confidence interval{CI}, 1.05 to 1.59]; 1.00; 1.12 [95% CI, 0.98 to 1.14 to 1.55], masing-masing). Hubungan ini linear pada peserta yang memiliki riwayat tidak pernah merokok (hazard ratio menurut kategori BMI : 1.12, 1.00, 1.16, 1.21, 1.36, dan 1.56, berturut-turut) tetapi hasil non-linear didapatkan pada peserta yang mempunyai riwayat merokok merokok (hazard ratio menurut kategori BMI : 1.32, 1.00, 1.09, 1.04, 1.14, dan 1.21) (P=0.04 untuk interaksi)

2. How precise was the estimate of the association (i.e. confidence intervals around the point estimates or p-values)?

1. Were the study participants similar to the patient in your practice?

-Does your patient match the study inclusion criteria?

-If not, are there compelling reasons whythe results should not apply to your patient?Pasien dalam penelitian mirip dengan pasien di lokasi saya. pasien memiliki DM dan riwayat merokok serta dengan obesitas.

2. Were all clinically important outcomes considered?Hasil penelitian ini berguna sebagai bukti untuk dapat memberikan edukasi pada pasien diabetes melitus dengan riwayat merokok

3. Do the results of this study fit with other available evidence?Ya,

Can you apply the results to patient care?