(Doc) How to Critically Appraise an Article

Running head: CRITICAL APPRAISAL
Critical Appraisal and Article Evaluation
Name of the Student
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Author Note

CRITICAL APPRAISAL
Introduction
For diabetic patients, it is extremely important that regular monitoring of blood
glucose is performed to achieve the glycemic goals (Pittman, Wright & Kushner, 2020).
Several different pre-analytical and analytical variables affect the blood glucose levels. Blood
glucose measurement can be taken by the healthcare professionals with the help of either
venous sample or capillary blood sample. Several past conducted pieces of literature have
debated over the disparity of the glucose values taken from these two samples (Andelin et al.,
2016). This topic has been chosen to remediate and narrow down the research findings on the
topic and provide a conclusive evidence to find and support the use of one blood collection
type over another.
The following sections of the paper will critically evaluate and appraise an article by
Adnan et al. (2015) that is concerned with the topic of discussion. The authors in this article
aim at finding correlation between venous and capillary blood glucose levels in diabetic
patients. With the help of critical appraisal of the research article, the validity of the research
findings and reliability will be adjudged to confirm the inclusion of the research article for
the chosen topic.
Findings
The research study conducted by Adnan et al. (2015) is highly relevant with the
chosen topic as it aims to find a correlation between the venous and capillary blood glucose
levels in samples collected from diabetic patients. To critically evaluate the research study
and conclude on its validity and reliability, Joanna Briggs Institute Critical Appraisal
Checklist will be used. The research conducted by Adnan et al., has cross sectional study
design, for which the JBI critical appraisal checklist for analytical cross sectional studies will
be used to appraise the research study (Joanna Briggs Institute, 2017).

CRITICAL APPRAISAL
The criteria for inclusion of potential participants in the sample is not clearly defined
in the research article. No information has been made available on the criteria chosen for
inclusion or exclusion of the participants. This information is critical for any research study
and its presence helps to determine the strength of external validity (Patino & Ferreira, 2018).
Sufficient details regarding the demographics of the participants have been provide in
the study. The subjects included 71% of women and 29% men, all of them diagnosed with
type-2 diabetes mellitus. The mean age of the selected patients is 52 ± 12 years, 56% of the
total 70 selected subjects were literate, with average duration of suffering from diabetes 12 ±
8 years and 90% of the selected participants had the socioeconomic status of being poor.
The researchers mention that the demographics characteristics of the subjects and
their associated clinical information were recorded to conduct the research study. However,
so data is made available to readers to let them know about how these data were collected.
The exposure of the socioeconomic status and exposure duration to type-2 diabetes is not
validated by a reliable data collection measure, which keeps the reliability of data
insignificant. It is important that a study clearly describes the measurement method of
exposure on which the validity can be assessed. Only with adequate description on the
method of measurement, the appropriateness of the current measures can be determined and
the study can be determined to be having gold standards.
To achieve the objectives of the research study, the researchers used reliable devices
for taking clinical measurements. Glucometer was used to measure capillary blood glucose
and UV-visible spectrophotometer was used to measure venous plasma glucose levels. The
study includes patients diagnosed with type-2 diabetes mellitus and the methods to determine
the blood glucose levels and further measurements used in the study are adequate and reliable
(Audu et al., 2017). This decreases any risk of bias and increases the usefulness of the
approach to match the characteristics of the group.

CRITICAL APPRAISAL
The researchers fail to address the confounding factors in the study effectively. The
only confounding factor identified by the researchers in the study is the literacy status of the
patients, whether they were illiterate or literate. In the study, 44% of the patients were found
to be illiterate and the results focused on this baseline characteristics to be addressed
properly. However, other confounding factors such as prognostic factors of concomitant
exposures such as smoking were not included in the final adjustment of the research findings.
The research study identifies socio-economic status of majority of the sample size to be poor,
but fails to correlate it with the findings on proper use of glucometers by the patients.
Moreover, there is no mention of findings adjusted with the baseline character of gender of
the subjects, which could have been a potential determinant of the research findings. The
study fails to identify other potential confounders as well, such as the age of the patients,
which could have influenced the direction of the results from the study (Johansson et al.,
2018). It can be concluded that the researchers have failed to identify the potential
confounders and measure them, highly increasing the insignificance of the research findings
for clinical interpretation and decreasing its validity for use in future as supporting piece of
evidence (Pourhoseingholi, Baghestani & Vahedi, 2012).
Another critical confounding factor that is specific to this research study is the time
when glucose tests are performed and whether the participants were fasting or the
measurement was made for postprandial glucose levels. The research article states that only
25% of the total 70 patients were monitored for both of postprandial and fasting glucose
levels. There is clear disparity in the presentation of information and no efforts to deal with
such confounding factors with the help of matching or other strategy has been applied.
In addition to this, no significant strategies to deal with the stated confounding factors
were made in the research study. The only identified confounding factor in the research study
is the literacy status of the patient. The absence of strategies to deal with confounding factors

CRITICAL APPRAISAL
is putting greater level of threat to the validity of the research findings making it critically
insignificant and unreliable.
The primary objective of the study was to determine the correlation between the
capillary and venous blood glucose levels in type-2 diabetic patients. The researchers identify
to make dose adjustments and prescribe treatments, there is a significant need of rapid blood
glucose level determination. To draw comparison between the detected blood glucose levels
from different samples of capillary and venous, the researchers use standard devices
including glucometer and UV-Visible spectrophotometer from known brands. Even though
successful establishment of objectivity of the outcome measurement is present, there is no
detailed information regarding the how the measurement was conducted, who conducted it
and whether they were professionally trained to use the instruments. This also refrains the
research study from providing any details on the clinical experience of the data collector and
their level of responsibility in the research study (Goodell, Stage & Cooke, 2016). A little
mention of two individuals who provided technical support for the glucose testing is
provided, which also lacks the credibility as provides no further details other than the names.
To carry out statistical analysis of the data collected, the researchers have used
Statistical Package for Social Sciences v21 provided by IBM. As per the research hypotheses,
there would be positive correlation between mean venous and mean capillary glucose levels
if there is significant difference of P≤ 0.05. The final mean difference observed after
statistical analysis was 0.84 mmol/L after mean results of venous glucose levels at 11.73 ±
4.64 and capillary glucose level of 12.57 ± 5.21 mmol/L, for which P < 0.001, thus denoting
significant differences between the measure values.
The authors mention that for glucose levels near normal, there is less significant
difference, which increases with the increase of blood sugar levels, that is, at elevated glucose
levels, greater significant difference is observed. Thus, a positive correlation coefficient

CRITICAL APPRAISAL
presents strong association between the venous and capillary glucose measurements,
fulfilling the objective of the study (Topping et al., 2019).
Conclusion
The research study has relevance with the actual topic of difference in the use of
capillary versus venous glucose level for glucose testing in diabetic people. The research
findings direct that with increase in glucose levels of the blood, which is normal in condition
of hyperglycemia during diabetes, there is a significant difference in the readings of blood
glucose levels observed from venous versus capillary. However, the research study itself has
many weaknesses with high threats to internal validity of the study. Even though the research
findings are generalizable, the drawbacks of the research study, aforementioned, keep the
overall validity of the research study significantly low. Poor credibility and reliability is
associated with the research study makes it poor choice for inclusion in the particular chosen
topic. Thus, it can be concluded from the above critical appraisal and analysis of the article
that the research study, with its greater proportion of weakness and drawbacks, cannot be
included to support the chosen research topic of difference between the use of venous and
capillary blood glucose in glucose testing for diabetic patients.

CRITICAL APPRAISAL
References
Adnan, M., Imam, F., Shabbir, I., Ali, Z., & Rahat, T. (2015). Correlation between capillary
and venous blood glucose levels in diabetic patients. Asian Biomedicine, 9(1), 55-59.
Andelin, M., Kropff, J., Matuleviciene, V., Joseph, J. I., Attvall, S., Theodorsson, E., ... &
Haraldsson, B. (2016). Assessing the accuracy of continuous glucose monitoring
(CGM) calibrated with capillary values using capillary or venous glucose levels as a
reference. Journal of diabetes science and technology, 10(4), 876-884.
Audu, S. I., Ubwa, S. T., Igbum, O. G., Ikese, O. C., & Alex, N. I. (2017) Performance
Evaluation And Analytical Comparison Between Glucose Meters And
Spectrophotometric Methods For Blood Glucose Determination.
Goodell, L. S., Stage, V. C., & Cooke, N. K. (2016). Practical qualitative research strategies:
Training interviewers and coders. Journal of Nutrition Education and
Behavior, 48(8), 578-585.
Joanna Briggs Institute. (2017). JBI critical appraisal checklist for analytical cross sectional
studies. 2016.
Johansson, M., Lind, M., Jansson, J. H., Fhärm, E., & Johansson, L. (2018). Fasting plasma
glucose, oral glucose tolerance test, and the risk of first-time venous
thromboembolism. A report from the VEINS cohort study. Thrombosis research, 165,
86-94.
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies:
definitions and why they matter. Jornal Brasileiro de Pneumologia, 44(2), 84-84.
Pittman, I., Wright, E., & Kushner, P. (2020). Monitoring Glucose Fluctuations in Patients
With Type 2 Diabetes: The Importance of Maintaining Glucose Control. The Medical
Roundtable General Medicine Edition.

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Pourhoseingholi, M. A., Baghestani, A. R., & Vahedi, M. (2012). How to control
confounding effects by statistical analysis. Gastroenterology and Hepatology from
bed to bench, 5(2), 79.
Topping, J., Reardon, M., Coleman, J., Hunter, B., Shojima-Perera, H., Thyer, L., &
Simpson, P. (2019). A Comparison of Venous versus Capillary Blood Samples when
Measuring Blood Glucose Using a Point-of-Care, Capillary-Based
Glucometer. Prehospital and Disaster Medicine, 34(5), 506-509.