I.

Analisis PICO a. Patient/Problem (P) : anak-anak. resiko diabetes b. Intervention (I) : pengaturan gaya hidup. c. Comparison (C) : tidak mendapatkan pengaturan gaya hidup d. Outcome (O) : efektivitas pengaturan gaya hidup dalam menurunkan kejadian diabetes

II.

Menyusun Good Clinical Answerable Question Apakah pada anak-anak usia sekolah pengaturan gaya hidup efektif menurunkan angka kejadian terkena diabetes?

III.

Penelusuran Evidence Melalui website Pubmed : http://www.nejm.org Kata kunci : intervention; diabetes; reduction

Dipilih artikel:

A School-Based Intervention for Diabetes Risk Education T. Baranowski, L. Adams, J. Baranowski, A. Canada, K.W. Cullen, M.H. Dobbins, R.Jago, A. Oceguera, A.X. Rodriguez, C.Speich, L.T. Tatum, D. Thompson, M.A. White, C.G. Williams, L. Goldberg, D. Cusimano, L. DeBar, D. Elliot, H.M. Grund, K. Khuel, S.McCormick, E. Moe, J.B. Roullet, D. Stadler, G.D. Foster, J. Brown, B. Creighton, M. Faith, E.G. Ford, H. Glick, S. Kumanyika, J. Nachmani, J. Rosen, L. Rosen, S. Sherman, S. Solomon, A. Virus, S.L. Volpe, S. Willi, D. Cooper, S. Bassin, S. Bruecker, D. Ford, P. Galassetti, S. Greenfield, J. Hartstein, M. Krause, N. Opgrand, Y. Rodriguez, M. Schneider, J.S. Harrell, A. Anderson, T. Blackshear, J. Buse, J. Bridgman, A. Gerstel, C. Giles, W. Hall, A. Jessup, P. Kennel, R. Matthews, R.G. McMurray, D. Rubin, A.M. Siega-Riz, M. Smith, A. Steckler, A. Stringer, A.

Zeveloff, M.D. Marcus, M. Carter, S. Clayton, B. Gilis, K. Hindes, J. Jakicic, R. Meehan, R. Noll, T. Songer, J. Vanucci, E.M. Venditti, R. Trevio, A. Garcia, D. Hale, A.E. Hernandez, I. Hernandez, C. Mobley, T. Murray, K. Surapiboonchai, Z. Yin, F. Kaufman, K. Resnicow, M. Goran, M. Engelgau, L.Y. Wang, P. Zhang, K. Hirst, K.L. Drews, S. Edelstein, L. El ghormli, L.S. Firrel, M. huang, P.K. Feit, S.L. Mazzuto, T. Pham, A. Wheeler. B. Linder, C. Hunter, M. Staten, S.M. Marcovina, P. Nader, M. Chin, S. Dagogo-Jack, L. Dolan, M. Espeland, R. Pate, D. Schatz. 2010;363:443-53, 27 Juni 2010

ABSTRACT

Background We examined the effects of a multicomponent, school-based program addressing risk factors for diabetes among children whose race or ethnic group and ssocioeconomic status placed them at high risk for obesity and type 2 diabetes. Methods Using a cluster design, we randomly assigned 42 schools to either a multicomponent school-based intervention (21 schools) or assessment only (control, 21 schools). A total of 4603 students participated (mean [ SD] age, 11.30.6 years; 54.2% Hispanic and 18.0% black; 52.7 girls). At the beginning of 6th grade and the end of 8th grade, student underwent measurement of body-mass index (BMI), waist circumference, and fasting glucose and insulin levels. Results There was a decrease in the primary outcome the combined prevalence of overweight and obesity in both the intervention and control schools, with no significant difference between the school groups. The intervention schools had greater reductions in the secondary outcomes of BMI z score, percentage of students with waist circumference at or above the 90th percentile, fasting insulin levels (P=0.04 for all comparisons), and prevalence of obesity (P=0.05). Similar findings were

observed among students who were at or above the 85 percentile for BMI at baseline. Less than 3% of the students who were screened had an adverse event; the proportions were nearly equivalent in the intervention and control schools. Conclusions Our comprehensive school-based program did not result in greater decreases in the combined prevalence of overweight and obesity than those that occurred in control schools. However, the intervention did result in significantly greater reductions in various indexes of adiposity. These changes may reduce the risk of childhood-onset type 2 diabetes.

IV.

Jawaban Pertanyaan Klinik Peran sekolah dalam mengatur gaya hidup pada anak-anak usia sekolah tidak efektif dalam menurunkan angka kejadian diabetes secara spesifik

V.

Level of Evidence Level Level 1 Criteria i. Independent interpretation of test results (without knowledge of the result of the diagnostic or gold standard ii. Independent interpretation of the diagnostic standard (without knowledge of the test result) iii. Selection of people suspected (but not known) to have the disorder iv. Reproducible description of both the test and diagnostic standard v. At least 50 patient with and 50 patients without the disorder Level 2 Meets 4 of the level 1 criteria

Level 3 Level 4

Meets 3 of the level 1 criteria Meets 1 or 2 of the level 1 criteria

Tabel 2. Level of Recommendation Grade Grade A Grade B Grade C Grade D Criteria The best evidence was at Level 1 The best evidence was at Level 2 The best evidence was at Level 3 The best evidence was at Level 4

Hasil penelitian diagnosis double blinding : 3 (C)

VI.

Critical Appraisal

A. Are the results of the trial valid? Screening Questions Yes Cant Tell Did the trial address a clearly focused issue? An issue can be 'focused' in terms of - the population studied - the intervention given - the comparator given - the outcomes considered Was the assignment of patients to treatments Page 2 of 11. We conducted a Pa No Page

randomized?

randomized-cluster design study

Were all of the patients who entered the trial properly accounted for at its conclusion - was follow up complete? - were patients analysed in the groups to which they were randomised? Were patients, health workers and study personnel blind to treatment? - were the patients - were the health workers - were the study personnel Were the groups similar at the start of the trial? In terms of other factors that might effect the outcome such as age, sex, social class Aside from the experimental intervention, were the groups treated equally?

Page Page 2 of 11. Students enrolled in

B. What are the results?

Screening Questions

Yes

Cant Tell

No

Page Page 2 of 11. The primary outcomes was combined prevalence of overweight & obesity. Secondary outcomes included obesity, BMI z score, and continuous & categorical measurement of wais circumference, fasting glucose level, and fasting insulin level

How large was the treatment effect? What outcomes are measured?

How precise was the estimate of the treatment effect? What are its confidence limits?

C. Will the results help locally? Screening Questions Yes Cant Tell Can the results be applied to No Page

the local population? Do you think that the patients covered by the trial are similar enough to your population? Were all clinically important outcomes considered? If not, does this affect the decision? Are the benefits worth the harms and costs? This is unlikely to be addressed by the trial. But what do you think?