The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study

Maysm N. Mohamad; Leila Cheikh Ismail; Lily Stojanovska; Vasso Apostolopoulos; Jack Feehan; Amjad H. Jarrar; Ayesha S. Al Dhaheri

doi:10.1371/journal.pone.0252884

Peer Review History

Original SubmissionDecember 8, 2020
13 Apr 2021 Decision Letter - Muhammad Sajid Hamid Akash, Editor PONE-D-20-38524 The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study PLOS ONE Dear Dr. Feehan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. The reviewers have criticized the methodology and selection criteria of the study. You are invited to revise your manuscript keeping in view that your revision will be re-evaluated by the reviewers. Moreover, when you revise the manuscript, pay special intention to remove all the possible grammatical mistakes and syntax errors. Please submit your revised manuscript by May 28 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols We look forward to receiving your revised manuscript. Kind regards, Muhammad Sajid Hamid Akash Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. You indicated that you had ethical approval for your study. In your Methods section, please ensure you have also stated whether you obtained consent from parents or guardians of the minors included in the study or whether the research ethics committee or IRB specifically waived the need for their consent. Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] 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: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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: No Reviewer #2: Yes ****** 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: Dear Editor Muhammad Sajid Hamid Akash, PhD TITLE: The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study Author: Maysm Nezar Mohamad et al. Comments to the Author This manuscript nicely presented, an interesting finding that the cross-sectional study of 555 female college students aged 17-25, enrolled at United Arab Emirates University in Al Ain, UAE. The Anthropometric analysis, blood pressure, and various biochemical markers were measured using standard methods. Type 2 Diabetes, impaired fasting plasma glucose (FPG), and elevated HbA1c levels were examined in the study. Overall, these findings are important and interesting. However, further, improvement is necessary to solidify the Manuscript. Here are a few comments and questions: 1. When this study was conducted? Please rationalize the selection of target population. Why the aged 17– 25 students are selected? 2. How you elaborated the other marker like blood pressure with diabetes or pre-diabetic cases? 3. Why only university students were focused, please add in the study limitation and justify the sampling biased. 4. What is the major objective of the study? Please focus on it. If its correlation, please explain it well. 5. Correction needed in writing "SPSS software, version 26.0 (SPSS, Chicago, IL, UASA)". 6. Explain about each test where Univariate and where multivariate logistic regressions was applied. Authors address these deficiencies, then the manuscript should be considered for publication. Reviewer #2: Very good study need some modifications Please Justify, why the female population of university student was targeted ? What is the correlation of other parameters with HBa1C ? Please rationalize the study in introduction? When this study was conducted ? Over all alignment of paper is urgently needed ****** 6. 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: Yes: DR.MUHAMMAD TARIQ Reviewer #2: Yes:** Muhammad Majid Aziz [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. Attachments Attachment Submitted filename: PONE-D-20-38524_reviewer Coments .pdf https://doi.org/10.1371/journal.pone.0252884.r001
Revision 1
18 May 2021 Author Response Comments to the Author Reviewer 1 This manuscript nicely presented, an interesting finding that the cross-sectional study of 555 female college students aged 17-25, enrolled at United Arab Emirates University in Al Ain, UAE. The Anthropometric analysis, blood pressure, and various biochemical markers were measured using standard methods. Type 2 Diabetes, impaired fasting plasma glucose (FPG), and elevated HbA1c levels were examined in the study. Overall, these findings are important and interesting. However, further, improvement is necessary to solidify the Manuscript. Here are a few comments and questions: Point 1: 1. When this study was conducted? Please rationalize the selection of target population. Why the aged 17– 25 students are selected? Response 1: Thank you for your kind feedback and valuable comment. The study was conducted between January 2014 and May 2016 as part of a PhD dissertation, yet we believe that the research findings are still relevant and the method of using both HbA1C and FPG is novel and would add value to the current literature in the UAE. Moreover, the rationale behind selecting the target population has been added to the introduction of the study (line 92-96/ page 4) “focusing on young adults to identify opportunities for early intervention is essential, as there is scope to prevent the transition from prediabetic to diabetic, and potentially reverse the early stage of T2D. Moreover, there is no previous research to date identifying risk factors of altered glucose metabolism using HbA1c and FPG among female young adults.”. In addition, the population structure of the UAE is mainly young adults and was therefore greatly affected by the rapid socioeconomic changes in the country. Point 2: 2. How you elaborated the other marker like blood pressure with diabetes or pre-diabetic cases? Response 2: We thank the reviewer for this valuable observation. Among the study population 11.3% were found to have stage 1 or stage 2 hypertension. However, when logistic regression analysis was conducted (Table 3), no association between high blood pressure and increased risk of abnormal glycemic status was revealed. Moreover, other risk factors for diabetes and cardiovascular disease were discussed in section 3.4 (line 254-277 / page 10-11) Table 3. Point 3: 3. Why only university students were focused, please add in the study limitation and justify the sampling biased. Response 3: Thank you for your observation. Typically, university students are making the transition from adolescence to adulthood, and during this period they are often forming long-lasting diet and health behaviors that are associated with an increased lifetime risk of type 2 diabetes. Furthermore, to address this concern the limitations section in the discussion has been modified (line 366-369/page 16) “It is acknowledged that this study has a number of limitations. Firstly, the use of convenience sampling strategy and restricting the sample to female university students. Therefore, the findings may not be extrapolated to all female young adults or non-university population in the UAE, nor applied to male cohort of the same age.” Point 4: 4. What is the major objective of the study? Please focus on it. If its correlation, please explain it well. Response 4: Thank you for your comment. The major objective of this study was to assess the prevalence of prediabetes and T2D among a sample of young Emirati female adults and to identify their risk for altered glucose metabolism. To address this concern, the objectives in the abstract and introduction have been revised and updated accordingly. Point 5: 5. Correction needed in writing "SPSS software, version 26.0 (SPSS, Chicago, IL, UASA)". Response 5: Thank you for your observation. The sentence has been corrected as suggested “USA” (line 195/page 7) Point 6: 6. Explain about each test where Univariate and where multivariate logistic regressions was applied. Response 6: We thank the reviewer for the constructive comment and agree that it might have been confusing where logistic regression analysis was applied. Therefore, the statistical analyses section (section 2.4) has been updated to include the following paragraph (line 198-201/ page 7) “Univariate and multivariate logistic regressions were used to study the association between age, family history of diabetes or hypertension, blood Pressure, body mass index, body fat, waist circumference, waist-hip ratio, hemoglobin, triglyceride, total Cholesterol, LDL, HDL, High-Sensitivity C-Reactive Protein with abnormal glycemic status as the outcome variable.”. Moreover, the results of the of the logistic regression analysis (Table 3) are presented in section 3.4 (line 254-277 / page 10-11) Table 3. Authors address these deficiencies, then the manuscript should be considered for publication. Reviewer 2 Very good study need some modifications Point 1: Please Justify, why the female population of university student was targeted? Response 1: Thank you for your observation. Typically, university students are making the transition from adolescence to adulthood, and during this period they are often forming long-lasting diet and health behaviors that are associated with an increased lifetime risk of type 2 diabetes. Moreover, it is usually very challenging to recruit Emirati young adults and measure their anthropometrics due to cultural restriction. Additionally, to address this concern the limitations section in the discussion has been modified (line 366-372/page 16) “It is acknowledged that this study has a number of limitations. Firstly, the use of convenience sampling strategy and restricting the sample to female university students. Therefore, the findings may not be extrapolated to all female young adults or non-university population in the UAE, nor applied to male cohort of the same age.” “In addition, studying female students only does not allow for examination of gender differences” Point 2: What is the correlation of other parameters with HBa1C? Response 2: Thank you for this comment. As the ADA recommends the simultaneous measurement of FPG and HbA1c (FPG and/or HbA1C), abnormal glycemic status based on both FPG and HbA1c was used in Table 3 to examine risk factors of diabetes. Logistic regression analysis in Table 3 revealed a correlation between abnormal glycemic status (based on both FPG and HbA1c) and decreased high-density lipoprotein (HDL) level and elevated high-sensitivity C-reactive protein (Hs-CRP) level. Point 3: Please rationalize the study in introduction? Response 3: Thank you for your comment. Kindly note that the rationale behind selecting the target population has been added to the introduction of the study (line 92-96/ page 4) “focusing on young adults to identify opportunities for early intervention is essential, as there is scope to prevent the transition from prediabetic to diabetic, and potentially reverse the early stage of T2D. Moreover, there is no previous research to date identifying risk factors of altered glucose metabolism using HbA1c and FPG among female young adults.”. In addition, the population structure of the UAE is mainly young adults and was therefore greatly affected by the rapid socioeconomic changes in the country. Point 4: When this study was conducted? Response 4: Thank you for your valid point. The study was conducted between January 2014 and May 2016 as part of a PhD dissertation, yet we believe that the research findings are still relevant and the method of using both HbA1C and FPG is novel and would add value to the current literature in the UAE. https://doi.org/10.1371/journal.pone.0252884.r002
25 May 2021 Decision Letter - Muhammad Sajid Hamid Akash, Editor The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study PONE-D-20-38524R1 Dear Dr. Feehan, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Muhammad Sajid Hamid Akash Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0252884.r003
Formally Accepted
10 Jun 2021 Acceptance Letter - Muhammad Sajid Hamid Akash, Editor PONE-D-20-38524R1 The prevalence of diabetes amongst young Emirati female adults in the United Arab Emirates: A cross-sectional study Dear Dr. Feehan: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Muhammad Sajid Hamid Akash Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0252884.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .