PONE-D-22-15528Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult diabetic patients in Ethiopia: ROC analysisPLOS ONE

Dear Dr. Oumer, 

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 August 19, 2022. 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,

Donovan Anthony McGrowder, PhD., MA., MSc

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. Thank you for stating the following in the Funding Section of your manuscript: 

"This research was fully funded by Dire Dawa University under the competitive research grant in 2021/22. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. "

We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form. 

Please remove any funding-related text from the manuscript and let us know how you would like to update your Funding Statement. Currently, your Funding Statement reads as follows: 

"Yes, This research was fully funded by Dire Dawa University under the competitive research grant in 2021/22. The funders had no role in study design, data collection and analysis, the decision to publish, or the preparation of the manuscript. "

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

3. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

Important: If there are ethical or legal restrictions to sharing your data publicly, please explain these restrictions in detail. Please see our guidelines for more information on what we consider unacceptable restrictions to publicly sharing data: http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Note that it is not acceptable for the authors to be the sole named individuals responsible for ensuring data access.

We will update your Data Availability statement to reflect the information you provide in your cover letter.

Additional Editor Comments:

Dear Dr. Oumer,

The manuscript was revised in accordance with the reviewers’ comments and is provisionally accepted pending final checks for formatting and technical requirements.

Regards,

Dr. Donovan McGrowder (Academic Editor)<o:p></o:p>

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

**********

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: 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: An interesting point of view - relying on anthropometrics rather than lab tests to diagnose diabetes.

The authors have done a study examining several different measurements of weight / size and glucose control in an area of the world with limited resources. The work is original and the data appear to be correct.

To improve the paper i have several suggestions:

1. Please remove a lot of extraneous information - for example table 1 shows us baseline data but it is never used afterwards to tell us who is or is not overweight or has a high WC.. Hence this info can be removed... Likewise Figure 1 is not needed. The information does not relate to the theme of the paper

2. You do not have to present so much data on sample size determination. Just give the number needed to reach valid calculations.

3. Make the INTRO shorter. Simply state Ethiopia has limited resources for medical care. Laboratory testing especially in rural areas is difficult to do. Given these circumstances you sought to see which anthropometric values could be used as surrogate markers of glucose control. Such simple statements make it clear to the reader what you are looking for. You may also state you are doing this in Ethiopia and trying to validate what has been reported in the West.

4. Consider loosening your criteria for poor control. 130 is actually excellent control for DM. How about looking at a fasting glucose of 150 or 180 or an A1c over 8%?

5. Please focus the DISCUSSION on the cut points and their sensitivity / specificity. Discuss your results and what they mean. Do not pay so much attention to other studies. After all your results are specific to Ethiopia not to other countries.

6. Finally in the DISC you bring up BMI but rarely mention it before. If you are going to include BMI then discuss it in the INTRO so that the reader knows to look for it.

You can basically cut the paper in half in terms of size and lose no information of value if the paper is succinct.

Reviewer #2: Congrats to authors

Kindly to review below comments

The definition of good glycemic control based on FBG (line 151 and other places) has not been a valid point so far as also mentioned as a limitation by the authors. The known international guidelines regarding management of diabetes have set targets for FBG but has not defined a criterion to label “good glycemic control” for a patient based on it. HbA1c and, more recently, time in range for glucose by CGMs are the mostly used descriptions for good diabetes control. Suggest changing the term “good glycemic control” to “good fasting plasma glucose” avoid the gap in the information, unless taking about glycemic control based on HbA1c.

Authors mentioned in line 52 that fasting blood glucose below 70 mg/dl is considered “uncontrolled diabetes”, while this could be true in a sense that glucose is not at target range, but it is not associated with the typical cardiovascular or renal complications of diabetes related to uncontrolled hyperglycemia. Consider removing “below 70” or indicate a different section talking about hypoglycemia specific complications. Line 25 eluded to the same idea, though not described as in line 52, consider also rephrasing line 25.

This allegation of self-monitoring of blood glucose improves diabetes control (mentioned in lines 61-65) is very subjective and depends on many factors, including type of diabetes and therapy used. Even though it is an important tool to monitor diabetes control, the evidence is not yet conclusive. Also reference 9 is for type 1 diabetes which are very specific group of patients, cannot use it to generalize it to all patients with diabetes. Consider rephrasing or removing it. The same paragraph repeated in lines 76-78.

Suggest rephrasing “DM patients” to “patients with DM” in the following lines: Lines 101, 106, 107, 138, 142, 229, 242 (twice), 267, 428, 431, 434

Suggest rephrasing “diabetes patients” to “patients with diabetes”: Lines 21, 23, 102, 103

Suggest rephrasing “diabetic patients” to “patients with diabetes”: Lines 282, 299, 300, 315

Below more specific points to consider

• Line 18: The word poorly should start with a capital letter. Also, the sentence is missing an end, a huge burden of what?

• Line 28: The word “Receiver” should start with a small letter

• Line 29: Add AUC initials following “area under the curve”

• Line 31: Not well written in the part (where 300), suggest rewrite

• Line 33: What are “WHR” and “WHtR”, those initials were never described in the previous text

• Line 38: The word “poor” should start with a capital letter

• Line 40: The word “anthropometric” should start with a capital letter

• What happened to reference 4?

• Line 59: To mention that this data is in Ethiopia

• Line 61: Suggest rephrasing “diabetic patients” to “patients with diabetes”

• Lines 66-68: More points about glucose self-monitoring even though the manuscript is concerning a very different topic.

• Initials AOR have not been described in the manuscript

• Lines 88-98: Much information mentioned here about census and populations, but no references mentioned.

• Line 107: The word “study” possibly missing a following word “period”

• Lines 107-109: It is very sufficient and understandable to mention that patients with DM who were pregnant, were excluded without further explanation.

• Sample size determination: section is very detailed, summary would be best

• Ethical considerations: section is very detailed, summary would be best

• Line 228: Consider removing “of clients”

• Line 231: Add respectively at the end of the sentence.

• Line 232: Re-write the value “105924.3%”

• Line 239: Consider removing “of DM patients”

• Line 242: Change “where” to “while”

• Line 260-261: The terms “undernourished” and “overnourished” seems less scientific terms, consider changing them.

• The two figures are not clear, quality id not optimal

• Line 267: Not well written in the part (where 330), suggest rewrite

• Magnitude of glycemic control: not clear from the text if the differences between associated values were significant or not

• Table 4 has not been labeled and seems attached to table 3

• Line 336: Consider changing “DM clients” to “patients with diabetes”

• Line 347: Not understandable sentence, rephrase

• Discussion: Three pages long is extensive for a discussion, recommend shortening

**********

[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.

Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult patients with diabetes in Ethiopia: ROC analysis

PONE-D-22-15528R1

Dear Dr. Oumer,

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,

Donovan Anthony McGrowder, PhD., MA., MSc

Academic Editor

PLOS ONE

Dear Dr.Oumer,

The manuscript was revised in accordance with the reviewers’ comments and is provisionally accepted pending final checks for formatting and technical requirements.

Regards,

Dr. Donovan McGrowder (Academic Editor)<o:p></o:p>