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How to Use PICO in Clinical Practice

How to Use PICO in Clinical Practice
So that’s how for practice now. Say you have a patient Mr. B who is a type 2 diabetic patient and one day he came to your pharmacy and asked if he can put on the new anti-diabetic agent as your t2 and lose weight as he saw on the news story. So you look at the news report and they said there is a patient Mr. Chen who put on the SGL-T2 inhibitor for 2 months and not only his hemoglobin A1c was well controlled he also lost 4 kilograms of his body weight in two months. So in order to answer the questions from your patient Mr. B you started to formulate a Pico.
The P is your patient so that will be the type 2 diabetic patient. I will be the intervention that you are interested in in this case, it will be an SGL-T2 inhibitor that Mr. B was really interested in C will be the comparison. In this case because we are not compared SGL-T2 inhibitor with other anti-diabetic agent so I put placebo here. But if the scenario is that you want to compare the SGL-T2 inhibitor with other agents like metformin and insulin then you will put other agents in the comparison. O is the outcome that we want to look at. In this case it will be the weight loss.
And because SGL-T2 inhibitor is anti-diabetic agent, so maybe in other cases the outcome you want to look at can be blood sugar control but in this case we use weight-loss here. So once we form our PICO, we can start to perform the literature search. So we can use the master that I introduced earlier in the PubMed. So the search turned out I want to use will usually be the ones I put in my pickle.
So here in this case I use SGL-T2 inhibitor and weight loss as my search turns and then I can also go to the pubmed clinical queries that I introduced earlier, and I also used the SGL-T2 inhibitor in weight loss as my search turns and then I choose the clinical study categories because I want to look at any studies that’s relevant to clinical studies. When I combined the search results from using match database in clinical queries, and then also limited my search type to randomized controlled trials, I found 21 randomized control trials. So the next step is to review these 22 randomized control trials. You can start with looking at the abstracts of these 22 rare RCTs.
And then after reviewing all these 22, 21 articles, I was able to exclude 17 studies because they are not totally fitted into my scenario. Some of the studies actually use a SGL-T2 inhibitor as an add-on therapy that means the patient has already been on other anti-diabetic agents like metformin insulin or glitazon. And thus SGL-T2 was the second anti-diabetic agents but that didn’t really fit into my case my case. In my case I want to use SGL-T2 inhibitor as the only anti-diabetic agent. And some of the study look at different outcomes like what pressure quality of life with the outcome I’m interested was weight loss. So for those looking at different outcomes I want to exclude.
The studies so after I was excluding 17 studies I was able to narrow my finding into four studies I listed the reference lists here. And then I further want to consider the patient population since we are in Taiwan I want to look at if any studies are studied on Asians. So two out of the four study that I found were studied on Asians. So I listed the references here. Both the studies were using dapagliflozin and as their SGL-T2 inhibitor. After I found the studies that want to look at the next step is to evaluate these studies in order to answer your Pico question. So here I made a comparison table out of the two studies that I’ve found.
So you can see the patient populations are all Asians and the study designs of these two studies were a randomized double-blind placebo-controlled trial. The study duration were 24 weeks that would be 6 months. The intervention here in the both studies were dapagliflozin versus placebo. The outcomes that they look at will be the hemoglobin A1c the blood sugar and also the total body weight change. So here are the results from these two studies.
In terms of the blood sugar control, clearly you see the SGL-T2 inhibitor can significantly reduce patient’s hemoglobin A1c in six months and when we look at the weight loss we were able to see an average of 2.98 kilograms and 2.25 kilograms reduced of weight in six months in these two studies respectively. In summary the studies does show that SGL-T2 inhibitor can significantly lowered the patient’s hemoglobin A1c and the average weight loss is around two to three quadrants in six months. So in order to answer Mr.
B’s question you can tell him that using a SGL-T2 inhibitor does lowers your hemoglobin A1c and can control your blood sugar but the average weight loss is around two to three programs in six months. So not to the extents how you saw on the news. So actually for most patients if they put on the SGL-T2 inhibitor they may not lose so much weight as you saw on the news stories. This concludes my presentation, thank you.

In this video, Dr. Yen-Ying Lee demonstrates the whole process of applying PICO in a case.

This time, our type II diabetic patient, Mr. B, asked that if the new anti-diabetic agent, a SGLT-2 inhibitor, can reduce weight as he saw on the news?

We should recognize PICO first. The patient belongs to type II DM patients, and the intervention is the SGLT2 inhibitor. The comparison will be a placebo, and the outcome will be weight loss. Once we form our PICO, we can start to perform the literature search.

When searching for suitable materials, we can limit the search type to randomized controlled trials, and choose the clinical study categories, then we will get 22 randomized control trials.

After reviewing them, we have to exclude studies that are not fit into the case scenario. Next, consider the patient population and start to evaluate the efficacy.

Finally, we get the summary that the average weight loss is around 2-3kg in 6 months, which is not as much as the news says.

This is the end of this week, if you have any question or thoughts, please leave them below.

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Evidence-Based Medicine in Clinical Pharmacy Practice

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