PONE-D-22-14329Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A prospective observational studyPLOS ONE

Dear Dr. Rosaria Caprino

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.

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We look forward to receiving your revised manuscript.

Kind regards,

Pracheth Raghuveer, MD, DNB

Academic Editor

PLOS ONE

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Additional Editor Comments: STROBE diagram needs to be added. There are many grammatical errors that need correction. The discussion needs improvement. 

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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: Partly

Reviewer #3: Partly

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: I Don't Know

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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

Reviewer #3: 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

Reviewer #3: 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: 1. sample size could have been increased for better inference.

2. few grammatical mistakes are there , please correct it.

3. please clarify , wether during telemedicine patient can see (Video interaction) their physician or not.

Reviewer #2: 1. This is a single cohort study without a control group during the Covid-19 pandemic when in person services were interrupted due to restrictions.

2. While methodology is sound the paper needs to be viewed in perspective.

3. This being a simple observational study it is not understood in what way “Standards of Good Clinical Practice and ICH Harmonized Tripartite Guidelines” were applicable in this study. These guidelines are for clinical trials.

4. Some care is better than no care. People around the world were numbed during the unprecedented severe restrictions in this period.

5. In such an environment even tele-consultation would have been welcome. The study findings need to be interpreted against this background.

6. Perhaps another study using same methods but in a post-pandemic setting would complement this study. Can be a recommendation in this paper.

7. Post pandemic tele-consultation lessons learned could be useful for delivering medical care in underserved and remote areas. However, the temptation to overuse it in normal settings should be checked.

8. May consider discussing some of these issues in the paper.

Reviewer #3: Dear author,

Thank you for undertaking this research to analyse the perceptions of patients on telehealth.

Overall the article is reasonably well presented. However I suggest that the following issues be addressed.

1. The setting needs to be well explained. The nature of the clinical practice (teaching or non teaching clinic), the characteristics of patients that are captured in this clinical practice whether it is a public or a private practice and the population that the clinic covers.

2. A STROBE diagram seems essential. Ideally it could start from the number of patients that attended the clinic during the study period number of type 2 diabetics, number who underwent tele health consultations and the number of patients who took part in the study. It is interesting that all 250 consecutive participants consented for the study and participated without any issues.

3. Sample size calculation has not been addressed. Starting from the hypothesis of this study, the reason as to how the number 250 was arrived at needs to be described clearly.

4. Regarding the study design, I disagree if this is a cohort study. There is no follow-up of patients. It seems to be a cross sectional study looking at the perspectives of type 2 diabetics who have attended tele-health consultation

5. While collecting baseline characteristics, a few other details could have been added. For example the sex distribution of the participants. Also the educational status, current occupation would indicate how tech savvy the patients would have been to participate in tele-health consultations.

6. The fact that this is a mixed method study with a qualitative component (the last open ended question of the questionnaire) the responses are ideally described as themes, sub themes and specific quotes. Also in the methodology section, there is paucity of information as to how this qualitative data was analysed.

7. The manuscript lacks a limitations section- even the best of studies will have its own limitations. It needs to be acknowledged.

8. In the discussion section, the generisability of the results need to be discussed. If similar results are expected in other parts of Italy or around the world.

9. Is there any specific reason why only type 2 diabetics were chosen and not any other types of diabetics?

10. The discussion seems to be more focused on BMI and the perception. But it is to be emphasised that there was a lack of statistical significance between the two, though there seemed to be a similar trend.

In summary, the above issues need to be addressed before considering this manuscript for publication.

Thank you for giving me the opportunity to review this manuscript.

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Reviewer #1: Yes: Divendu Bhushan

Reviewer #2: Yes: Professor Amitav Banerjee, MD

Reviewer #3: No

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PONE-D-22-14329R1Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A prospective observational studyPLOS ONE

Dear Dr. Caprino,

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 Dec 31 2022 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: https://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,

Pracheth Raghuveer, MD, DNB

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.

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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 #3: 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 #3: Yes

**********

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

Reviewer #1: I Don't Know

Reviewer #3: I Don't Know

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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 #3: 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: Yes

Reviewer #3: 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 #3: Dear authors,

Thank you for addressing the queries / suggestions. I suggest that the following be clarified in the manuscript.

1. Being a cross-sectional study, the words "prospective" and "consecutive" can be removed. They are usually used in the context of a prospective cohort study. From your methodology section, it appears that you have chosen all 254 patients who attended the practice within the given time period.

2. In the STROBE diagram, there have been 2463 patients between March and May 2020, however only 254 between July and August 2020. Is there a reason why the numbers dramatically reduced?

3. As raised by one of the other reviewers, whether Telehealth consultation refers to a video call/consultation or just an audio telephonic call with email communication needs to be clarified better.

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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.

[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.

Telemedicine and its acceptance by patients with type 2 diabetes mellitus at a single care center during the COVID-19 emergency: A cross-sectional observational study

PONE-D-22-14329R2

Dear Dr. Caprino,

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.

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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,

Pracheth Raghuveer, MD, DNB

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 #3: 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: Partly

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #3: I Don't Know

**********

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 #3: 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: Yes

Reviewer #3: 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: Author has responded to all points raised last time and did required modifications. This manuscript is technically sound and data given support the conclusion. Although author mentioned the difficulties , these can be better summarized as barrier to the tele medicine method of consultation. Statistical analysis appear good to me, but expert opinion can be taken.

Reviewer #3: Thank you for addressing my queries and suggestions. I am happy to accept the manuscript with the existing corrections.

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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: Yes: This article showed benefits and barriers of telemedicine consultations. During COVID era, it was used as a great tool to serve people. For looking satisfaction and more details of barriers , qualitative studies can be done. Divendu Bhushan

Reviewer #3: Yes: Vignesh Kumar Chandiraseharan

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