PONE-D-21-20037

Health-related quality of life of patients with type 2 diabetes mellitus​ at a tertiary care hospital in Ethiopia

PLOS ONE

Dear Dr. Gebremariam,

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Academic Editor

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: Yes

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: No

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: No

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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: Thank you for the invitation to review this manuscript which reports the results of a survey on health-related quality of life of patients with type 2 diabetes mellitus at a tertiary care hospital in Ethiopia. This is much needed and long overdue work, and I commend the authors for conducting this work. The manuscript reads well and has several methodological strengths including the use of a validated Amharic version of EQ-5D-5L instrument, which can be regarded as a good source of evidence for conducting economic evaluations.

My only comment is around the sampling strategy. The authors mentioned that a total of 360 T2DM patients were interviewed. While the recruitment strategy is clear, the sampling techniques and assumptions behind the number “360” is not clear. I also recommend explaining “consecutive sampling method” in a bit more detail here.

Result, analysis, and discussion are well executed and well written.

Reviewer #2: Thank you for the opportunity to review this interesting paper. The study measured health related quality of life and identified associated factors among people with diabetes at a tertiary care hospital in Ethiopia. The study found a median (IQR) EQ-5D-5L utility and EQ-VAS scores of 0.95 (0.88-0.96) and 80 (75.0-85.0), respectively. The two dimensions of EQ-5D-5L for which the most health problems were reported were pain/discomfort (67.3%) and mobility (60.5%). Poor glycemic control, longer duration of diabetes, insulin usage, and being obese had significant negative association with HRQoL.

A very important strength of the study is the use of Ethiopian value sets which makes the findings very suitable for future economic evaluations in the country and other similar settings. However, the authors may want to consider the following points in their revision of the manuscript.

Major comments:

• The methods section provides no information on how sample size was determined and sampling was undertaken. This is important to comment on the appropriateness of inferences even at hospital level.

• While the use of generic instrument in the study is great, there are still benefits of using disease specific tools especially in countries such as Ethiopia where cost utility studies are rare. It would be interesting to consider this perspective in the discussion.

• The introduction is excellent in terms of discussing the factors affecting HRQoL of patients with diabetes. However, it would be great to have a succinct summary of previous HRQoL studies among patients with diabetes in Ethiopia instead of saying “However, there is a paucity of data on diabetic patient’s HRQoL in Ethiopia” even without any reference citation.

Minor comments:

• I am not sure if this is a personal preference but using phrases such as “people with diabetes” or “patients with diabetes” feels much better than “diabetic patients”

• The study hospital has been referred to as “tertiary care hospital” and Specialized Hospital at different parts in the paper. It would be to use one of these consistently throughout.

• In the conclusion of the abstract: I would include one or a couple of the main factor/s instead of leaving it as “several factors”

• According to Table 1, 32% of the respondents were illiterate? Can you please define what “illiterate” mean in this study? And how was the consent signing done for these respondents?

• Table 2 it would be better to present the order of “Yes” and “No” consistently

• Language issues: Although the paper’s message is not compromised due to language issues, there are some grammar issues and typo here and there. Therefore, a careful reading and editing is encouraged. The following are some examples I picked:

o “All data collectors had the training to ensure uniformity and reduce inter-observer bias in data collection.” Should be “All data collectors had a training to ensure uniformity and reduce inter-observer bias in data collection.”

o Page 7 line 160: “More than half (55.7%) of the patients were female; 249 (70.7%)…” should be “More than half (55.7%) of the patients were females; 249 (70.7%)…”. In addition, n(%) reporting has not been consistently followed.

o In Table 1, average monthly household income (ETB), average row there is some erroneously pasted number (2314.87 (2921.9))

o Page 8 line 168: “using lifestyle modifications”… adopting lifestyle modifications and…” The majority (76.4%) had one or more comorbidities”… The majority of patients (76.4%) had one or more comorbidities

o Page 10, line 192: The following sentence needs to state the comparators “On the other hand, patients who were living with diabetes for a longer duration and taking more than 5 medications had significantly lower EQ-5D-5L index and EQ-VAS scores compared to their counterparts with X and Y, respectively

o In Table 2, “Lifestyle modification use” can be more informative if paraphrased as “adoption of lifestyle modification” or similar. Similarly, in the same table, “obesity” should be written as “obese” and “> 2 complication” as “> 2 complications”

o Page 9 line 179: “The most frequent health problems were the pain/discomfort dimension” should be paraphrased as “The most frequent health problems were reported for the “pain/discomfort dimension”

o On page 10 line 189: The distribution of the EQ-5D-5L utility and EQ-VAS scores was were skewed => were skewed…

o Page 16 line 262: “Conversely, glycemic control had a negative correlation with EQ-5D-5L utility and EQ-VAS scores and similar findings were reported elsewhere” is not clear. Was it to mean poorer/weaker glycemic control had a negative correlation with…?

o Page 16 line 267: “suggesting that developing both complications are responsible for a remarkable decline…”

o Page 16 line 274: “I as noted by Tran…”…“The negative association between insulin usaged and…”

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Reviewer #1: No

Reviewer #2: Yes: Befikadu L. Wubishet

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Health-related quality of life of patients with type 2 diabetes mellitus​ at a tertiary care hospital in Ethiopia

PONE-D-21-20037R1

Dear Dr. Gebremariam,

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.

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Academic Editor

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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

**********

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: No

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: thank you for revising the manuscript "Health-related quality of life of patients with type 2 diabetes mellitus at a tertiary care hospital in Ethiopia" The comments have now been addressed satisfactorily.

Reviewer #2: Thank you for revising the paper. All the suggestions I had on the first draft have been addressed and I don't have any more suggestions for change.

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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: Yes: Befikadu Wubishet