Systematic Review Critique: GDM Prevalence and T2DM Risk

This report provides a detailed critique of a systematic review article by Zhu and Zhang (2016) focusing on the global prevalence of gestational diabetes mellitus (GDM) and its associated risk of progression to type 2 diabetes (T2DM). The critique assesses various aspects of the systematic review, including the clarity of the research problem and scope, the appropriateness of the search strategy, and the criteria used for selecting primary studies. The report evaluates the bibliographic databases, keywords, and supplementary efforts employed to identify relevant studies. It also examines the quality appraisal process, including the use of defined criteria and interrater reliability, as well as the methods for data extraction and analysis. The critique highlights the conclusions drawn by the reviewers, the limitations of the review, and the implications for nursing and healthcare practice, including the need for future research to address the variations in GDM prevalence and the factors influencing the progression to T2DM. The report notes the study's strengths in its systematic approach and the reasonable conclusions drawn from the data, while also acknowledging limitations such as the lack of data on the risk of progression to T2DM and the challenges in comparing data across economies with varied diagnostic criteria. Overall, the critique provides a comprehensive analysis of the systematic review's methodology, findings, and implications for healthcare professionals.

Running head: CRITIQUE OF SYSTEMATIC REVIEW 1
Critique of Systematic Review
Name
Institutional Affiliation

CRITIQUE OF SYSTEMATIC REVIEW 2
CRITIQUE OF SYSTEMATIC REVIEW
Article Reference (APA - 10 points)
Zhu, Y., & Zhang, C. (2016). Prevalence of gestational diabetes and risk of progression to type 2
diabetes: a global perspective. Current diabetes reports, 16(1), 7.
https://www.researchgate.net/profile/Yeyi_Zhu/publication/289601746_Prevalence_of_G
estational_Diabetes_and_Risk_of_Progression_to_Type_2_Diabetes_a_Global_Perspecti
ve/links/5b463bb7aca272c60937725a/Prevalence-of-Gestational-Diabetes-and-Risk-of-
Progression-to-Type-2-Diabetes-a-Global-Perspective.pdf
Critique of Systematic Review (90 points/5 points each)
1. The Problem
1. Did the report state the research problem and/or research questions?
Yes. The problem is stated as lack of sufficient assessment of global burden of
gestational diabetes mellitus (GDM) due to lacking of systematically synthesized data on
global GDM prevalence estimates specifically amongst developing economies (Zhu &
Zhang, 2016).
2. Is the scope of the project appropriate?
Yes. The scope of review covered overview of global GDM prevalence premised on
data published in previous decade, discussed methodological difficulties in global burden
estimation as well as discussed contributing factors linked to geographic variation in
prevalence of GDM and assessed adverse GDM health implications in regards to
progression to T2DM from a global viewpoint.
3. Was the approach to integration described, and was the approach appropriate?
Yes. The authors described the approach and it was appropriate.

CRITIQUE OF SYSTEMATIC REVIEW 3
Search Strategy
4. Did the report describe criteria for selecting primary studies, and are the criteria
defensible?
Yes. The criteria for selecting primary studies are described and remain defensible. In
phase 1, they reviewed abstract and titles to determine relevance of articles to the
research objective. In phase 2, they reviewed full texts of 214 articles to extract data on
sample size, study design, year, location, sampling strategy, diagnostic criteria, screening
approach, GDM prevalence and characteristics of subject. Only selected the most lately
published study in case of duplicate studies on same study population. Quality of every
eligible study was assessed using a scoring system developed by International Diabetes
Federation with 4 domains. In phase 3, suitable exclusion criteria was applied for further
synthesis which led to a final selection of 77 studies with the mean quality score of 4.60
(SD 0.80).
5. Were the bibliographic databases used by the reviewers identified, and are they
appropriate and comprehensive? Were key words identified?
Yes. The bibliographic database were identified and remain appropriate and
comprehensive with key words identified. The identified database included PubMed
supplemented by cross-checking appropriate references of eligible studies on GDP
prevalence in past decade beginning Jan 1, 2005 to August 1, 2005. Key terms identified
as gestational diabetes, prevalence, screening, diagnosis, type 2 diabetes and pregnancy.
6. Did the reviewers use supplementary efforts to identify relevant studies?
Yes. They use cross supplemented a literature search by cross-checking relevant
references of eligible studies on GDM prevalence in the previous decade beginning Jan

CRITIQUE OF SYSTEMATIC REVIEW 4
1, 2005 to August 1, 2005 to manifest contemporary illness prevalence with no language
limitation.
The Sample
7. Did the search strategy yield a good sample of studies?
Yes. Search strategy yielded a good sample of studies totalling to 3357 articles.
8. If a primary study report was lacking key information, did reviewers attempt to contact
the original researchers for additional information?
No.
Quality Appraisal
9. Did the reviewers appraise the quality of the primary studies? Did they use a well-
defined set of criteria or a validated quality appraisal scale?
Yes. Reviewers assessed quality of primary studies using a scoring system developed by
International Diabetes Federation with 4 domains with a well-defined set of criteria and a
validated quality appraisal scale.
10. Did two or more people do the appraisals, and was interrater reliability reported?
No. This is not precisely stated in the article.
11. Was quality information used effectively in selecting studies or analyzing results?
Yes. Reviewers effectively used quality info in the selection and analysis of results.
Quality info included sampling (score ranging between 0 and 3); data sources (score
ranging between 0 and 1), ascertainment of status of GDM (score ranging between 0 and
1) and study year (score ranging between 0 and 2). The upper scores were used to select
studies.
Data Extraction

CRITIQUE OF SYSTEMATIC REVIEW 5
12. Was adequate information extracted about the study design, sample characteristics,
and study findings?
Yes. The authors extracted sufficient info regarding study design, study findings and
sample characteristics by reviewing full texts of 214 articles.
13. Were steps taken to enhance the integrity of the data set (e.g., Were two or more people
used to extract and record information for analysis)?
No. This is not precisely indicated in the article.
Data Analysis—General
14. Did the reviewers explain their method of pooling and integrating the data?
Yes. The authors explained their methods of integrating and pooling the data.
15. Were tables, figures, and text used effectively to summarize findings?
Yes. The reviewers used figures, tables, and text appropriately to summarize the findings
(Polit & Beck, 2018). For instance major diagnostic criteria for GDM was summarized
on a table marked 1 while GDM prevalence estimates in hospital-based cohort in Spain
was expressed as percentages. A bar graph was used to summarize the country-specific
GDM prevalence (figure in the article) based on a range of diagnostic criteria.
Conclusions
16. Did the reviewers draw reasonable conclusions about their results and about the
quality of evidence relating to the research question?
Yes. Reviewers reasonably concluded that their review, anchored on publications in the
previous decade, showcased huge variations of global GDM prevalence with it being
highest amongst Middle East and North Africa, Southeast Asia, and Western Pacific
regions while being lowest in Europe.

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17. Were limitations of the review/synthesis noted?
Yes. The study was limited by lack of data on risk of progression to T2DM from GDM
alongside little knowledge regarding modifiable factors which might lower risk,
specifically amongst developing as well as low-to-middle income economies which have
more GDM and T2DM prevalence. Another limitation is the challenge of direct
comparison across economies partially due to varied diagnostic criteria, screening
approaches and underlying population characteristics.
18. Were implications for nursing and health care practice and further research clearly
stated?
Yes. The reviewers have stated that future studies should focus on estimating or re-
evaluating the GDM prevalence adopting novel IADPSG criteria that tend to culminate
in a higher prevalence estimate as opposed to other criteria utilized previously.

CRITIQUE OF SYSTEMATIC REVIEW 7
References
Polit D. F. & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence
for nursing practice (9th ed.). Philadelphia, PA: Wolters Kluwer, pp. 322, 323.
Zhu, Y., & Zhang, C. (2016). Prevalence of gestational diabetes and risk of progression to type 2
diabetes: a global perspective. Current diabetes reports, 16(1), 7.