PONE-D-19-35176

Opportunistic screening for type 2 diabetes in community pharmacies.  Results from a region-wide experience in Italy

PLOS ONE

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PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The study by Roberto Gnavi et al. aims to evaluate an opportunistic screening strategy based on FINDRISC score for the identification of individuals with type 2 diabetes in Italy.

I would like to applaud the authors impressive efforts of engaging and retain such a large number of pharmacies to voluntarily contribute to the study.

The manuscript is well written and data clearly presented. I have 2 major concerns:

1. The authors mention that no population screening is recommended in Italy. In contrast, North America has several screening guideline recommendations (American Association of Clinical Endocrinologists, American Diabetes Association, Canadian Task Force on Preventive Health Care, and U.S. Preventive Services Task Force) each with their individual set of parameters. What was the authors rationale to use FINDRISC score?

Was there any cost effectiveness analysis performed?

2. The authors mention in the Results section that “pharmacies were randomized to the two arms of the project and 443 were assigned to opportunistic screening”. It is unclear who are the subjects in the control group. The way it is initially described as a cross sectional study and it is not clear at what point randomization occurred. If there was a control group the authors need to describe the results for this group of patients: how many patients were diagnosed with DM in this group? If there was no control group the authors should present data on the pharmacies that were not assigned to the opportunistic screening and then compare it with the intervention group. In this way the validity of the FINDRISC score could be tested in this highly selected group.

Reviewer #2: Gnavi et al, used the FRINDISC questionnaire in community pharmacies to identify patients at risk for diabetes mellitus type 2 (DMT2) in overweight, diabetes free customers aged >45 years. Excluding the number of cases expected during one year follow-up, per 117 interviews one new case of DMT2 was identified. This is an interesting and important study that is easily implemented in daily practice,

Comments:

Results:

Page 9: age is part of the FRINDISC score, so it is evident that higher age is associated with a higher score. Please omit age in this sentence.

Table 1:

First line: either provide the numbers for men or women.

High pressure medication should be replaced by: anti-hypertensive medication.

High glicemic levels, should be replaced by “glycemic”. Please define hyperglycemia in the legenda of this Table.

Define: low physical activity and low vegetable consumption in the legend.

What do the authors mean by “familiarity”?

Table 2

“Glicemia” should be replaced by “glycemic”.

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Reviewer #1: No

Reviewer #2: No

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Opportunistic screening for type 2 diabetes in community pharmacies.  Results from a region-wide experience in Italy

PONE-D-19-35176R1

Dear Dr. Gnavi,

We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements.

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With kind regards,

Wen-Jun Tu

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors adequately addressed all the comments. It is an important study that has practical applicability in countries with high diabetes prevalence.

Reviewer #2: I have no further comments fort he authors. The questions are adequately addressed. I have uploaded my review the first time that I reviewed this manuscript.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No