PONE-D-22-19423Prognostic Nomogram for Uncontrolled Type 2 Diabetes Using Thailand Nation-wide Cross-sectional StudiesPLOS ONE

Dear Dr. Rangsin,

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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: Partly

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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?

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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: The manuscript was well written and easy to follow.

1. In Table 1. The FPG (mg/dL) was somehow wrong. It read mean+- SD equal to 36614.

In table 2-3. The percentage of each parameter in each HbA1c group should be in the sample group in stead of in-between group because N in each group were a lot difference. This would be easier to see the difference. For example, in the duration of diseases, the authors should compare the percentage in individuals in the sample HbA1C group.

2. The references have to be adjusted. There are still errors in capitalization in the titles of references.

3. Regarding the prediction of uncontrolled T2DM, it was well accepted that high FPG is strong predictor of uncontrolled diabetes. The problems these days are the individuals with good of borderline FPG who in fact have uncontrolled HbA1C (>8% or >9%). This is called "unaware uncontrolled diabetes". This group is in fact the real risk factors for developing of complications. Secondly, the better and practical measurement to determine glucose homeostasis and short-term glycemic control which is similar to oral glucose tolerance test and glucose-insulin homeostasis is the “random postprandial glucose”. This measure is easy and available to everyone and every hospital; however, is not widely used. I would think this should mention in the discussion for possible practical solution.

4. The authors mentioned in the “measurements” Section that lipid profiles were measured but they did not define the LDL levels in association with the lipid lowering medications if these results are in the control range. Please also define the definition of renal insufficiency, dyslipidemia, diabetes kidney diseases and else. For instance, if patients have LDL <100mg/dL with lipid lowering medication. Do they still considered dyslipidemia?

Reviewer #2: Authors have explored the feasibility of predictive nomogram for prognostic factors in type 2 diabetes. While they have come up with a long list of associated factors which help to identify poorly controlled diabetes, it is not practical to replace HbA1c testing on their so called risk estimation with predictive nomograms as patients tend to get worse from low risk to high risk. Therefore main message in this article is flawed however has some academic interest of read.

Specific comments:

In the abstract, it is useful to define what the authors considered as uncontrolled diabetes (line 38)

Background: Line 55: prevalence increased to 31% seem to be very high, do they mean by 31%?

Line 58: change the word diabetics to diabetes

Line 61: mortality including high glucose and diabetes: does not make sense, does it mean high glucose without confirmed diabetes? Please verify

Line 70: change the word a diagnosis to higher after the onset of diabetes (cardiovascular disease risk goes up whether diagnosed or not, it is the onset, diagnosis maybe delayed)

Line 79: change reduced to optimal HbA1c

Line 90: Sentence does not read well, verify

Line 92: Unable to grasp what is the relevance of MAP here, please verify this statement

Line 103 type 2 diabetes patients not diabetics

Table 1: FPG, is this value of sample size or actual FPG? (36614, 30396)

Line 280 and everywhere change the word diabetic to diabetes

Fig one is barely visible, I could not see. Unable to comment

351: Paragraph does not read well: are the authors proposing testing only those who have met the nomogram prediction with HbA1c and use the cost saved to treat dyslipidemia? 75% of your population is already treated with statin as per data, you should not introduce new concept unrelated to manuscript. Secondly, though your study and nomogram is based on cross sectional population, and has some predictive value, patients deteriorate and some one for instance has HbA1c of 7%, considered low risk according to the prediction model, there is no guarantee he/she will stay at 7%, that’s why periodic HbA1c testing is advocated.

Line 374: should be replaced by sugar and refined carbohydrates, excessive fat consumption

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Reviewer #1: Yes: korapat Mayurasakorn

Reviewer #2: Yes: A/Prof Shamasunder Acharya

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PONE-D-22-19423R1Prognostic Nomogram for Uncontrolled Type 2 Diabetes Using Thailand Nation-wide Cross-sectional StudiesPLOS ONE

Dear Dr. Rangsin,

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 29 2023 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,

Wen-Jun Tu

Academic Editor

PLOS ONE

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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 #2: All comments have been addressed

Reviewer #3: (No Response)

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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

Reviewer #3: Yes

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

Reviewer #2: Yes

Reviewer #3: 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 #2: Yes

Reviewer #3: (No Response)

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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

Reviewer #3: (No Response)

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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: thank you for addressing the comments. Could you please clarify this? Line 94-96 Thialnad’s tight control…. Does not make sense. Is this Thailand’s guidelines?

Reviewer #3: This study aimed to establish an effective prognostic nomogram for patients with uncontrolled T2DM through regression analysis. They utilized data through cross-sectional studies in 2018 and 2015 and ended up with a predictive nomogram of uncontrolled diabetes based on demographic characteristics, prescription medications, history of diabetic complication, and laboratory results.

1. Abstract. why use data 2018 for model building group and 2015 for validation group rather than the other way around?

2. Line 167. More details are needed for the variables. For example, smoking habits can be smoker vs non-smoker but it can be also smoker, non-smoker, vs. prior smoker. Similar concern applies to other variables.

3. Line 172. For reproducibility, please also provide ICD-10 code for each disease.

4. Line 180. Are all categorical variables binary?

5. Line 185. “the variance inflation factor variables were removed”. This doesn’t make sense. Also, what criteria was use? Please make sure to have statisticians involved in your study.

6. Line 187. Please provide the criteria for backward selection.

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Reviewer #2: No

Reviewer #3: No

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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.

Prognostic Nomogram for Uncontrolled Type 2 Diabetes Using Thailand Nation-wide Cross-sectional Studies

PONE-D-22-19423R2

Dear Dr. Rangsin,

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,

Wen-Jun Tu

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 #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 #3: (No Response)

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

Reviewer #3: (No Response)

**********

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: (No Response)

**********

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: (No Response)

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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: (No Response)

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Reviewer #3: No

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