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Critical Appraisal of Literature

In its October 5 th , 2020 issue, the Wiley Online Library journal published results on a
large clinical research study examining the progression and prognosis of COVID-19 among
patients with diabetes. The authors sought to establish whether diabetes is a risk factor
influencing the progression and prognosis of the novel coronavirus disease (COVID-19) first
reported in 2019 (Guo et al., 2020). First, the paper asks a clearly focused clinical question. The
question is clearly stated and appropriately expresses a relationship between the dependent and
independent variables.
Further, the question in the research has been substantiated by adequate experiential and
scientific background material. Specifically, the researchers state that the surface receptor for
SARS coronavirus (SARS-CoV) is angiotensin-converting enzyme 2 (ACE2) (Guo et al., 2020).
ACE2 was found in other studies to be widely expressed in different organ systems in the body,
such as the lungs, brain, kidneys, and cardiovascular organ system. Based on this, the researchers
found an explanation for the multiple organ failures that were experienced in some COVID-19
patients. Based on the known fact that diabetes mellitus is one of the leading causes of morbidity
globally, existing studies have found a higher susceptibility of this group of people to highly
infectious diseases. Such existing studies formed the basis of the study done in the article. The
researchers wanted to find out how exactly diabetes patients were affected by COVID-19 and
how different this was from patients without diabetes.
The population of interest is well defined, and in this case, the researchers wanted to find
out the effect of COVID-19 among diabetes patients, how the disease develops in these patients
and explains why attention should be given to diabetes patients who are affected by Covid-19.

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The outcomes of interest are obvious and early identified in the article. The authors advocate for
attention and more intensive care for diabetes patients affected by COVID-19 as the disease
increases the risk of other health-related complications such as severe pneumonia, excessive
uncontrolled inflammation responses, and release of tissue injury related enzymes (Guo et al.,
2020).
The study population was not recruited through a stratified sampling technique.
According to Taherdoost & Group (2017), stratified sampling entails dividing as population into
strata, and then a random sample is taken from each group. The study was carried out on 174
SARS-Cov-2 patients who were admitted to Wuhan Union hospital for a period of 19 days,
starting from February 10th and ending February 29th, 2020 (Guo et al., 2020). First, the
researchers divided the patients into two groups depending on whether or not they had diabetes.
In the second categorization, patients with other comorbidities other than diabetes were
separated. The researchers wanted to avoid capturing the impact of other comorbidities in their
research as they were only interested in diabetes. Then, the researchers separated the sample
again based on patients that had diabetes and those that did not. The study suggests a standard of
care by recommending that COVID-19 patients presenting with diabetes as comorbidity be given
more attention as they are at a risk of rapid deterioration. Remarkably, this study has a
comparison group, and this makes the conclusion founded as they showed the disparities
between laboratory tests, recovery records, and analysis of progression rates between admitted
patients with diabetes and patients without diabetes.
The search strategy adopted in the research article incorporates adequate and appropriate
resources that have been published, thus providing a basis for the assumptions made at the
beginning of the study. Additionally, the article has a conceptual framework that explains the

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path of the research, and this helps to firmly ground the research in conceptual constructs related
to the topic of study. The chosen framework helps make the research findings more acceptable
and meaningful in the research field. Also, it helps in the generalizability of the research
findings. The concepts form an impetus for the inquiry and provide direction throughout the
study. Further, the researchers used the experimental research design. Although the design
selected is not explicitly mentioned in the article, it is evident that the research conducted was
high in causal or internal validity. Given the nature of the research, the most appropriate design
was the experimental design.
Overall, the ethical concerns are addressed in the study. The authors state that the written
consent was waived by the Ethics Commission of Wuhan Union Hospital in China that dealt
with emerging infectious diseases (Guo et al., 2020). The authors, however, do not state whether
the patients gave informed consent and whether they were informed of their rights as participants
in the study. Waivers to informed consent may be issued when the research involves minimal
risk to the participants (Saritha & Sreedevi, 2020). The research demonstrates an example of a
research whose risks to the subject are minimal. This explains why the informed consent was
waived. Overall, the research study is accurate, broadly applicable, and its findings are valid;
hence it is replicable in the future.

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References

Guo, W., Li, M., Dong, Y., Zhou, H., Zhang, Z., Tian, C., … & Hu, D. (2020). Diabetes is a risk
factor for the progression and prognosis of COVID‐19. Diabetes/metabolism research
and reviews, 36(7), e3319.
Saritha, S. R., & Sreedevi, C. S. (2020). Informed Consent in Clinical Practice and Research and
Its Awareness among Under Graduate Medical Students. Indian Journal of Forensic
Medicine & Toxicology, 14(1).
Taherdoost, H. (2016). Group, H.(2017). Validity and Reliability of the Research Instrument;
How to Test the Validation of a Questionnaire/Survey in a Research.