Determinants of hypertension among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: A case-control study

Kehabtimer Shiferaw Kotiso; Nabiha Degemu; Samson Gebremedhin; Melaku Taye; Adane Petros; Fanuel Belayneh; Deneke Wolde; Dejene Hailu

doi:10.1371/journal.pone.0256399

Peer Review History

Original SubmissionApril 10, 2021
12 May 2021 Decision Letter - Yoshihiro Fukumoto, Editor PONE-D-21-08688 Determinants of hypertension among patients with type 2 diabetes on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: a case control study PLOS ONE Dear Dr. Kotiso, 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. Please submit your revised manuscript by Jun 26 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Yoshihiro Fukumoto 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. Please provide additional details regarding participant consent. In the ethics statement in the Methods and online submission information, please ensure that you have specified (1) whether consent was suitably informed and (2) what type you obtained (for instance, written or verbal). If your study included minors under age 18, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information. 3. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. 4. Please include captions for ALL your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [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: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No 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: Yes 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: This paper was a case-control study in diabetes patients in Ethiopia. The determinants of hypertension with T2DM were not physical exercise, glycemic control, smoking, alcohol intake, and education but obesity, activity, stress, duration of insulin, age, occupation, and family history of hypertension. The sample size is not so large and there was a selection bias between cases and controls. This manuscript is potentially interesting. However, there are some concerns in it. Major comments 1) The most serious concern is a selection bias in two groups between cases and controls, I suspected that. Authors need to analysis t-test and chi-square test, and address p value in tables. 2) The second concern is not a large sample size. Authors need to mention in the section of limitation. 3) This study insisted many variables are determinants of hypertension among diabetes. What variable is the strongest or most independent factor for hypertension with diabetes? If authors insist that there was an independent association, they would need to use multiple stepwise regression analyses. Minor comments 1) Table 1, 2, 3, and 4 were showed characteristics of patients in case and control. This manuscript have to put these tables in one. 2) There was no units for variables and no abbreviations lists in footnotes in Table 5. 3) LDL or HDL were LDL-cholesterole or HDL-cholesterol. 4) Tables were showed controls in left and cases in right. Table 6 was showed cases in left and controls in right. Tables were unified the writing. Reviewer #2: Thank you for the opportunity to review this manuscript. The authors provided an original article assessing the determinants of hypertension in patients with diabetes mellitus at TASH. They presented the article in a meaningful way, however, the following issues need to be fixed/ clarified to make it easier for the reader to follow, and make it methodologically sound. 1) Title: please specify the type of diabetes mellitus considered in the cohort (type 2 DM as indicated in the subsequent sections), including an addition of ‘mellitus’ in the phrase. Also, use a hyphen in ‘case control’. 2) Abstract: the phrase ‘type 2 diabetic patients’ needs revision, such as ‘patients with T2DM’. 3) Introduction: line 34: check, and revise references 23 and 24. Line 36: write the full form of WHO 4) Methods and materials: there is an inconsistency in the use of the terms; T2DM and/or type 2 DM. Please revise and apply one uniformly across the manuscript. The specific scheduled date of study period needs to be defined. The sample size estimation is barely defined which requires major revision. It is difficult to follow authors’ assumption (reference) of exposure variables among the cases and controls considered in the computation. As both groups emerge from a DM cohort, and that DM cannot, independently, predict hypertension among the cases only, the figure (OR=2.28) in line70, and how they came up with the stated sample size is still unclear. Sampling method of this study is not clear. For example, in lines 45-47, of the introduction summary, the authors indicated that participant selection flaws were a problem in earlier studies. As cases and controls are not apparent to researchers from the outset, using simple random sampling simply cannot be possible. It is imperative that authors clearly indicate the procedure showing how cases and controls were recruited. 5) Results: in line 155; ‘two-thirds’ for 62.4% appears unsound, and needs revision. Please check and revise table 5. Lines 203-204: the term ‘diabetic medications’, also requires to be rephrased. 6) Discussion: well discussed, however, the use of abbreviations for the first time should be avoided. Generally, the authors used some abbreviations throughout the paper without first presenting the full form. Authors are advised to have a look at on this terms, and fix for clarity. ****** 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: No Reviewer #2: No [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. https://doi.org/10.1371/journal.pone.0256399.r001
Revision 1
14 Jul 2021 Author Response Dear reviewers and editor, Thank you for your review and important issues you raised in the paper. We have read the reviewer's comments carefully and hope that the revised version now submitted will be regarded as having enhanced the previous version. The authors very welcome the reviewer's comments and suggestions. These contributions have appreciably improved the final paper quality. Hereunder, kindly get the responses to the points raised under each point. Response to editor We've checked your submission and before we can proceed, we need you to address the following issues: - Please include a legend for figure 1. BMI in the figure 1. was written in full in the revised figure, and the title of the figure was also included in the manuscript to locate the position of the figure. Response to reviewers 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: Yes Reviewer #2: Yes ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No 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: Yes 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: This paper was a case-control study in diabetes patients in Ethiopia. The determinants of hypertension with T2DM were not physical exercise, glycemic control, smoking, alcohol intake, and education but obesity, activity, stress, duration of insulin, age, occupation, and family history of hypertension. The sample size is not so large and there was a selection bias between cases and controls. This manuscript is potentially interesting. However, there are some concerns in it. Major comments 1) The most serious concern is a selection bias in two groups between cases and controls, I suspected that. Authors need to analysis t-test and chi-square test, and address p value in tables. Comment: The detail procedures of selecting the participants were added in the revised manuscript based on the reviewer’s comment. To eliminate selection bias, we randomly selected both the cases and controls using the digital record of the hospital, where the status and care of DM patients are regularly recorded. Because of the availability of digital record in the hospital, where the status and care of DM patients are regularly recorded per each visit to the diabetic clinic, we were able to generate sample frame from it for both cases and controls. For e.g. whether the patient has comorbidity including hypertension or not is recorded in the digital record, and all DM patients be screened for hypertension per each visit. As a result, those T2DM patients already recorded as hypertensive in the record were considered as list of cases, and the non-hypertensives as controls. In the process, the newly diagnosed cases were also managed accordingly. Comment: Bivariable binary logistic regression analysis was conducted instead of t-test and chi-square test for each variable (since the model can handle both continuous and categorical variables), and variables with a p-value of <0.25 were presented in table. 2) The second concern is not a large sample size. Authors need to mention in the section of limitation. Comment: Thank you for the issue you raised associated with the sample size. We stated under limitation that “The study might have also lacked power to detect an association between hypertension and rare exposures like a history of smoking.” to address the issue raised by the reviewer. 3) This study insisted many variables are determinants of hypertension among diabetes. What variable is the strongest or most independent factor for hypertension with diabetes? If authors insist that there was an independent association, they would need to use multiple stepwise regression analyses. Comment: In terms of measures of association (Odds ratio), obesity was the strongest independent factor of hypertension. However, it’s not to mean that variables (particularly the countinous one, such as age and stress score) with the least odds ratio are the weakest independent factor, because the odds ratio for these variables is difficult to be compared with the categorical variables for they have different interpretation. On another note, we have used enter method rather than the stepwise method for the analysis both because of the limitations associated with stepwise (as supposed by different statisticians) and the AIC signified the enter method as a best fitting model for our data as stated under “Data processing and analysis” Minor comments 1) Table 1, 2, 3, and 4 were showed characteristics of patients in case and control. This manuscript have to put these tables in one. Comment: Amendments were made based on the reviewer’s comment. 2) There was no units for variables and no abbreviations lists in footnotes in Table 5. Comment: Units were added, and abbreviation lists were put in footnotes in the revised manuscript. 3) LDL or HDL were LDL-cholesterole or HDL-cholesterol. Comment: Corrected based on the comment. 4) Tables were showed controls in left and cases in right. Table 6 was showed cases in left and controls in right. Tables were unified the writing. Comment: Corrected according to the comment. Reviewer #2: Thank you for the opportunity to review this manuscript. The authors provided an original article assessing the determinants of hypertension in patients with diabetes mellitus at TASH. They presented the article in a meaningful way, however, the following issues need to be fixed/ clarified to make it easier for the reader to follow, and make it methodologically sound. 1) Title: please specify the type of diabetes mellitus considered in the cohort (type 2 DM as indicated in the subsequent sections), including an addition of ‘mellitus’ in the phrase. Also, use a hyphen in ‘case control’. Comment: Corrected based on the comment. 2) Abstract: the phrase ‘type 2 diabetic patients’ needs revision, such as ‘patients with T2DM’. Comment: Revised based on the comment. 3) Introduction: line 34: check, and revise references 23 and 24. Comment: Checked and revised based on the reviewer’s comment. Line 36: write the full form of WHO Comment: WHO was written in full in the revised manuscript based on the reviewer’s comment. 4) Methods and materials: there is an inconsistency in the use of the terms; T2DM and/or type 2 DM. Please revise and apply one uniformly across the manuscript. Comment: Revised based on the comment The specific scheduled date of study period needs to be defined. Comment: The specific scheduled date was stated in the revised manuscript. The sample size estimation is barely defined which requires major revision. It is difficult to follow authors’ assumption (reference) of exposure variables among the cases and controls considered in the computation. As both groups emerge from a DM cohort, and that DM cannot, independently, predict hypertension among the cases only, the figure (OR=2.28) in line70, and how they came up with the stated sample size is still unclear. Comment: Sorry for the mistake made while editing for language. It was mistakenly written as “Proportion of controls” but now corrected as “proportion of controls with exposure.” The command that we used in stata to compute our sample size was “power twoproportions (0.4 (0.025)0.7), test(lrchi2) oratio(2.28) power(0.9) table.” To obtain larger sample size, we used a range for the proportion of controls with exposure ranging from 0.4 to 0.7, based on the pre-study estimate of 0.56. Finally, the proportion we used to estimate the sample size was 0.7 because of yielding the largest sample size. Sampling method of this study is not clear. For example, in lines 45-47, of the introduction summary, the authors indicated that participant selection flaws were a problem in earlier studies. As cases and controls are not apparent to researchers from the outset, using simple random sampling simply cannot be possible. It is imperative that authors clearly indicate the procedure showing how cases and controls were recruited. Comment: Flawed participant population selection was stated in the introduction summary to explain limitations of the previous studies due to the type of population participated in the studies which might bias and or confound the results (population selection rather than the sampling technique). To mention some of the major limitations, participants in whom HTN diagnosis precedes DM diagnosis were not excluded in the previous studies (Tadesse, Amare et al. 2018, Kotiso, Mekebo et al. 2020) regardless of the fact that this might contaminate the results by mixing-up factors determining for the development of DM in HTN patients (in whom the risk factors for HTN might be similar with that of the general population) rather than HTN in DM. Besides, the other study (Mariye, Girmay et al. 2019) included all DM patients which might also bias and confound the results unless properly controlled because of similarity in the pathophysiology of T2DM with that of HTN, and T2DM accounting the vast majority of DM population. Thus, this study tried to address the aforementioned issues to provide more meaningful and valid information. Because of the availability of digital record in the hospital, where the status and care of DM patients are regularly recorded per each visit to the diabetic clinic, we were able to generate sample frame from it for both cases and controls. For e.g. whether the patient has comorbidity including hypertension or not is recorded in the digital record, and all DM patients be screened for hypertension per each visit. As a result, those T2DM patients already recorded as hypertensive in the record were considered as list of cases, and the non-hypertensives as controls. In the process, the newly diagnosed cases were also managed accordingly. The detail procedures of sampling were added in the revised manuscript based on the reviewer’s comment. 5) Results: in line 155; ‘two-thirds’ for 62.4% appears unsound, and needs revision. Comment: It was addressed in the revised manuscript. Please check and revise table 5. Comment: table 5 was revised. Lines 203-204: the term ‘diabetic medications’, also requires to be rephrased. Comment: The phrase diabetic medication was rephrased as diabetes medication. 6) Discussion: well discussed, however, the use of abbreviations for the first time should be avoided. Generally, the authors used some abbreviations throughout the paper without first presenting the full form. Authors are advised to have a look at on this terms, and fix for clarity. Comment: All the abbreviation issues are fixed in the revised manuscript. Thank you for your consideration. We look forward to hearing from you. Sincerely, The authors Attachments Attachment Submitted filename: Rebuttal Letter.docx https://doi.org/10.1371/journal.pone.0256399.r002
31 Jul 2021 Decision Letter - Yoshihiro Fukumoto, Editor PONE-D-21-08688R1 Determinants of hypertension among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: a case-control study PLOS ONE Dear Dr. Kotiso, 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. Please submit your revised manuscript by Sep 14 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. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Yoshihiro Fukumoto Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 ******** 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: (No Response) Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: (No Response) Reviewer #2: Yes ****** 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: (No Response) Reviewer #2: Yes ****** 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 Response) Reviewer #2: Yes ****** 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: In table 2, units of mean SBP and DBP were mm Hg. This units need no space between mm and Hg. 'mmHg' In table 3, AOR in DM duration was 1.035(1.01, 1.07). AOR was needed to unified two alignment. Reviewer #2: Thank you again for presenting the revised form of your work. The authors have revised the manuscript incorporating comments suggested. I advise the inclusion of 'materials' in the methods sub-section of the abstract. Also please check the acknowledgement section for patients, while offering their full consent and participation, should have been acknowledged, or if that has been addressed elsewhere. ****** 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 [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. https://doi.org/10.1371/journal.pone.0256399.r003
Revision 2
31 Jul 2021 Author Response Dear reviewers, Thank you for your review and important issues you raised in the paper. We have read the reviewer's comments carefully and hope that the revised version now submitted will be regarded as having enhanced the previous version. The authors very welcome the reviewer's comments and suggestions. These contributions have appreciably improved the final paper quality. Hereunder, kindly get the responses to the points raised under each point. Response to reviewer #1: Review Comments to the Author Reviewer #1: In table 2, units of mean SBP and DBP were mm Hg. This units need no space between mm and Hg. 'mmHg' Comment: the spaces were removed and corrected as mmHG based on the reviewer’s comment. In table 3, AOR in DM duration was 1.035(1.01, 1.07). AOR was needed to unified two alignment. Comment: the decimal place was rounded to two places based on the reviewer’s comment. Response to Reviewer #2: Reviewer #2: Thank you again for presenting the revised form of your work. The authors have revised the manuscript incorporating comments suggested. I advise the inclusion of 'materials' in the methods sub-section of the abstract. Also please check the acknowledgement section for patients, while offering their full consent and participation, should have been acknowledged, or if that has been addressed elsewhere. Comment: materials was now included in the abstract subsection methods, and the study participants were also acknowledged in the revised version based on the reviewer’s comment. Thank you for your consideration. We look forward to hearing from you. Sincerely, The corresponding author Attachments Attachment Submitted filename: Rebuttal Letter2.docx https://doi.org/10.1371/journal.pone.0256399.r004
6 Aug 2021 Decision Letter - Yoshihiro Fukumoto, Editor Determinants of hypertension among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: a case-control study PONE-D-21-08688R2 Dear Dr. Kotiso, 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, Yoshihiro Fukumoto 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 ******** 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 ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 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 ****** 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: Yes Reviewer #2: Yes ****** 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: (No Response) Reviewer #2: I have found the paper meaningful and with potential contribution to practice. I have no objection to its present form thus far. ****** 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 https://doi.org/10.1371/journal.pone.0256399.r005
Formally Accepted
13 Aug 2021 Acceptance Letter - Yoshihiro Fukumoto, Editor PONE-D-21-08688R2 Determinants of hypertension among patients with type 2 diabetes mellitus on follow-up at Tikur Anbessa Specialized Hospital, Addis Ababa: a case-control study Dear Dr. Kotiso: 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. Yoshihiro Fukumoto Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0256399.r006

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 .