Systematic Reviews
Copyright ©The Author(s) 2019.
World J Diabetes. Feb 15, 2019; 10(2): 96-113
Published online Feb 15, 2019. doi: 10.4239/wjd.v10.i2.96
Table 4 GRADE assessment for long-term effectiveness of RJ treatment on glycemic control
GRADE criteriaRatingSupport for judgementOverall quality of evidence
Outcome: Long term glycemic control (n = 14 studies)
RoB (assessed on Cochrane RoB Collaboration Tool)NoOnly one study had low RoB for all categories. Most studies had at least one item at high or unclear RoBHigh
Serious (-1)1
Very serious (-2)
InconsistencyNoGenerally, positive clinical effects demonstrated but some studies indicate null effects. There are also large variations in magnitude of effect. Heterogeneity is notable between the studies (in population, intervention and outcome assessment)Moderate
Serious (-1) 1
Very serious (-2)
IndirectnessNo1Evidence synthesized from studies addresses review question with respect to population, interventions and outcomeLow1
Serious (-1)
Very serious (-2)
ImprecisionNoAll studies have groups with small sample sizes (≤ 20), with no indication that they meet required sample sizes to detect difference in outcome; observable but statistically insignificant measures in many studies suggest sample sizes were too small to detect difference. 95% confidence intervals of effect size estimates mostly suggest an appreciable benefit for treatment, but there are several that suggest possibility of no meaningful effectVery low
Serious (-1)
Very serious (-2) 1
Publication biasUndetected1There is chance of publication bias considering the review is entirely “small-scale” trials; this area of research is not well-established and there is potential for publication bias, but none was overtly detected
Strongly suspected (-1)
OtherLarge effect (+11 or +2)Standardized mean difference of studies (effect size) indicates large magnitude of effect of treatment. Dose-response relationships observed
Dose response (+11 or +2)
No plausible confounding (+1 or +2)