PONE-D-21-37088The performance of a Finnish Diabetes Risk score (FINDRISC) in detecting undiagnosed diabetes among Kenyan adults aged 18-69 years.PLOS ONE

Dear Dr. Mugume

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Reviewers' comments:

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Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: No

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Reviewer #1: Yes

Reviewer #2: 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: It is very interesting to use a risk score in pickup people at risk in low economic countries, the key is to evaluate a suitable existing engine tool and revise it to adopt in a sepecific population. You had done a valuable study, and found a simplifies risk score to cover most of the people at risk.

Reviewer #2: The theme of this paper is important and have huge potential benefit to the developing nations. The major issue is that the conclusion of this paper lack significant statistical support. I suggest the authors to significantly increase the sample size for statistically significant conclusion

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Reviewer #1: Yes: Benli Su, Dept of Endocrinology and Metabolism, Second Hospital of Dalian Medical University, Dalian, China

Reviewer #2: No

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PONE-D-21-37088R1Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18-69 years.PLOS ONE

Dear Dr. Mugume 

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 10, 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,

Xianwu Cheng, M.D., Ph.D., FAHA

Academic Editor

PLOS ONE

Additional Editor Comments (if provided):

The original reviewers have decliend to revew second peer-review.

Thus, this academc editor have recruited new additional reviewers.

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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 #3: (No Response)

Reviewer #4: 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 #3: Partly

Reviewer #4: Yes

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

Reviewer #3: Yes

Reviewer #4: Yes

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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 #3: Yes

Reviewer #4: 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 #3: Yes

Reviewer #4: 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: General Comments

In this study, using a modified and simplified FINRISC to detect undiagnosed diabetes in 4027 Kenyans aged 18-69 years, the authors examined how correct this inference of being diabetic. They found that this screening was acceptable to Kenyans, as already reported in some countries. They concluded that the simplified FINDRISC can distinguish individuals in a more cost-effective way, with or without diabetes. Statistical analysis seems sound. The manuscript is well written.

I have the following concerns:

Specific comments

1.　Sensitivity, specificity, and diagnostic accuracy depend on the prevalence of diabetes and are also influenced by race and lifestyle. As the author discussed in the text, there are quite a few reports on the accuracy of FINRISC for diabetes screening, including reports from Africa. The results shown here are unattractive.

2.　The original Finnish diabetes risk score was applied to subjects aged 35-64 years who were not treated with anti-diabetic drugs and was prospectively followed up for ∼10 years on the onset of diabetes, but the subjects recruited in this study were 27 to 60 years old (median 35 years, younger than the original study, where subjects were getting older during the follow-up of ∼10 years). The method and subject were different from this study. The original study predicted new cases of diabetes during the follow-up of ∼10 years. The meaning is different from this study. The results obtained here cannot be compared to the original results.

3.　Even If this screening contributes to the detection of diabetes, is its use really useful? Determination of HbA1c and blood glucose levels is essential for the diagnosis of diabetes. If you want to diagnose current diabetes instead of predicting future diabetes, you should determine them. Those costs are not high.

4.　Line210: The number of subjects is wrong. 137, not 136.

Reviewer #4: The sample size question previously asked has been adequately answered.

You could say in the discussion that your sample size, while limited by the prior collection before this analysis was undertaken, is still comparable to those in other studies such as the original study in Finland and the one in Philippines.

I am a new reviewer and have not seen the paper before. I have no major concerns.

I do have some suggestions on improving the paper for the reader.

Introduction page 4 line 57 suggest change to "inconvenient"

In the first sentence of the last paragraph of the introduction add that FINDRISC was originally developed and used to predict risk of developing T2DM but has also been used to detect diabetes References 26,27,28.

Study design Suggest move "conducted between April and June 2015" to household survey "conducted between April and June 2015" AND designed to...

Definitions

Omitting the 2 hour OGTT glucose will miss some cases. That's inevitable in this analysis but should be noted in the limitations. See Diabetic Medicine 2000 17(10): 741-745

Criteria for BMI and waist circumference. Are these the ones appropriate for this ethnic group. Please specify.

Original Finnish (FINDRISC) diabetes risk score

A score of 21 or more predicts a 50% likelihood of developing T2DM in the next 10 years. What score do they use as a cut off for detecting DM which is what you are doing. Please include both these points here.

Modified FINDRISC It says personal history of diabetes was collected while in the original FINDRISK it was a history of a high glucose. You should note this here. The same applies for simplified FINDRISC. Also table 1 has high blood glucose history. It needs to be very clear and the text and table should be consistent.

Table 3 has LR and text has LHR.

Discussion Last paragraph suggest >>"contributeS to the quality of care standard..

Omitting the 2 hour OGTT glucose will miss some cases. That's inevitable in this analysis but should be noted in the limitations. See Diabetic Medicine 2000 17(10): 741-745

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Reviewer #3: No

Reviewer #4: No

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Performance of a Finnish Diabetes Risk Score in detecting undiagnosed diabetes among Kenyans aged 18-69 years.

PONE-D-21-37088R2

Dear Dr. Mugume

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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Kind regards,

Xianwu Cheng, M.D., Ph.D., FAHA

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Although two original reviewers (#2 and #3), the all concerns raised four reviewers have addressed by the authors two round peer-review processes.

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 #4: 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 #4: Yes

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

Reviewer #4: Yes

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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 #4: 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 #4: 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 #4: Thank you for your responses and modifications to the text. The issues raised have been adequately addressed in the revision

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Reviewer #4: No

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