PONE-D-23-21626The efficacy of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

Dear Dr. Chowdhury,

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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ACADEMIC EDITOR:  please add further detail in the background on the rationale for the review i.e., specifically whether and what similar reviews have been done in HMICs or other LMICs. Be specific as to whether the gap the authors are addressing is the lack of a review focused LMICs in general

Please kindly clearly address the following points :

This systematic review and meta-analysis was registered with PROSPERO (CRD: 42022364447)

a. was the protocol review published ?

b.The PROSPERO registration number did not retrieve the protocol. please check and confirm the PROSPERO registration number

c. Methods: Please provide the comprehensive search strategy for all databases in appendix/ supplementary file.

d.The purpose of the meta-analysis is unclear, particularly in terms of how it relates to the study aim.

e. please add include section of an assessment of the risk of bias of the included studies in this review .I would recommend version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2)

Ref: Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from www.training.cochrane.org/handbook.

f. please add the evidence grading section by using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations)

h.the limitations of the evidence base and the eligible literature are discussed but not the limitations of the review==============================

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Academic Editor

PLOS ONE

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Additional Editor Comments:

please add further detail in the background on the rationale for the review i.e., specifically whether and what similar reviews have been done in HMICs or other LMICs. Be specific as to whether the gap the authors are addressing is the lack of a review focused LMICs in general

This systematic review and meta-analysis was registered with PROSPERO (CRD: 42022364447)

a. was the protocol review published ?

b.The PROSPERO registration number did not retrieve the protocol. please check and confirm the PROSPERO registration number

c. Methods: Please provide the comprehensive search strategy for all databases in appendix/ supplementary file.

d.The purpose of the meta-analysis is unclear, particularly in terms of how it relates to the study aim.

e. please add include section of an assessment of the risk of bias of the included studies in this review .I would recommend version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2)

Ref: Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC. Chapter 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.4 (updated August 2023). Cochrane, 2023. Available from www.training.cochrane.org/handbook.

f. please add the evidence grading section by using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations)

h.the limitations of the evidence base and the eligible literature are discussed but not the limitations of the review

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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: Partly

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: Yes

Reviewer #2: No

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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

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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: I appreciate the effort of the authors. Please find my comments as follows:

1. Methods: Page 4 - Authors have mentioned that they followed the PRISMA guidelines. Authors should follow the updated guidelines (PRISMA 2020). The reference 34 should be updated accordingly. However, the supplementary file shows the PRISMA 2020 checklist. It should be updated in the main text and reference.

2. Methods: Authors have provided the comprehensive search strategy for Medline in appendix. As per the PRISMA 2020 guidelines, the comprehensive search strategy for all databases should be provided in appendix/ supplementary file.

3. In systematic reviews, two independent review authors screen the articles. The authors have mentioned that “Finally, three authors (HAC, BNS and ST) independently reviewed the full text of the remaining records.” This is confusing and needs clarification.

4. In the PRISMA flow diagram, authors have mentioned that “Articles included in qualitative synthesis [n=43]”. This is inappropriate. Qualitative synthesis or qualitative evidence synthesis (QES) denotes a specific method of synthesising qualitative research. Authors should mention “Articles included in synthesis [n=43]” / “Articles included in narrative synthesis [n=43]”.

5. There should be assessment of certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. The 22nd point of PRISMA 2020 checklist is as follows: “Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.” Authors have mentioned that it has been described in Pages 9, 10, 31. However, in reality, the certainty of evidence has not been assessed. GRADE certainty of evidence should be presented using Summary of Findings (SoF) tables.

6. Abstract: The authors have mentioned that “The risk of bias was evaluated using Eager’s regression test and funnel plot.” This is incorrect. Publication bias was assessed using Eager’s regression test and funnel plot. Risk of bias and publication bias are different.

7. Abstract: Authors should assess the certainty of evidence and provide the certainty level while presenting the results.

8. The search was conducted in August 2022. The search should be updated up to 30 June 2023 (or later).

Reviewer #2: The authors conduct a SR and MA to estimate the effect size of DSME interventions on glycaemic control and CMD risk in LMIC . This is Generally a well written paper and article follows the PRISMA guidelines.

Included below are a few suggestions for improvement.

Title

In the title consider replacing efficacy with effectiveness. DSME interventions tend to be more pragmatic.

Abstract

In the Abstract, consider using reduction in CVD risk rather than improvement in CVD as the later is less subjective

Introduction

Tha investigators site the paucity of data on effectiveness of DSME interventions in LMIC in the introduction. The investigators may find these articles we have recently published useful:

Lamptey R, Amoakoh-Coleman M, Barker MM, Iddi S, Hadjiconstantinou M, Davies M, Darko D, Agyepong I, Acheampong F, Commey M, Yawson A. Change in glycaemic control with structured diabetes self-management education in urban low-resource settings: multicentre randomised trial of effectiveness. BMC Health Services Research. 2023 Dec;23(1):1-9.

Lamptey R, Amoakoh-Coleman M, Djobalar B, Grobbee DE, Adjei GO, Klipstein-Grobusch K. Diabetes self-management education interventions and self-management in low-resource settings; a mixed methods study. Plos one. 2023 Jul 14;18(7):e0286974.

Methods

The methods have been described in sufficient detail to allow reproducibility however the search string has not been provided. If the word limit is a limitation please consider providing the search string and diagrammatic representation of the results of the ROB assessment as part of supplementary materials.. The PROSPERO registration number did not retrieve the protocol. Kindly check and confirm the PROSPERO registration number . Please provide also the date the review was registered.

Results: To improve the readability of the results investigators should consider rounding numbers greater than 10 to whole numbers; p-values can be presented to 2 decimal places at a maximum instead of 4. There are several statements where the authors fail to provide a reference to support the results. The articles included in this systematic review and meta-analysis should be referenced when ever the authors refer to them.

Discussion

Includes relevant literature and situates the findings well. The discussions stem from the results presented and provide adequate interpretation of the findings.

Conclusion

The conclusions are stated too strongly given the limitations of the review e.g the results of the ROB of included studies. Investigators may consider hedging e.g. they study MAY have found a positive effect...

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Reviewer #1: Yes: KM Saif-Ur-Rahman

Reviewer #2: Yes: Roberta Lamptey

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The effectiveness of diabetes self-management education intervention on glycaemic control and cardiometabolic risk in adults with type 2 diabetes in low- and middle-income countries: A systematic review and meta-analysis

PONE-D-23-21626R1

Dear Dr. Hasina 

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,

Mahmoud M Werfalli, PhD

Academic Editor

PLOS ONE

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 #2: Yes

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

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 #2: 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 #2: 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 #2: No further comments. All comments raised have been sufficiently addressed. The paper is much stronger

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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 #2: Yes: Dr Roberta Lamptey

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