PONE-D-24-31087Association of METS-IR Index with Type 2 Diabetes: A Cross-sectional Analysis of National Health and Nutrition Examination Survey Data from 2009 to 2018PLOS ONE

Dear Dr. Han,

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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?

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: 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: 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: 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: The study is highly significant and offers valuable insights, particularly in addressing non-communicable diseases such as Type 2 Diabetes. The manuscript is well-written and clearly articulated. The METS-IR metric merits further exploration to better understand its causal relationship with Diabetes Mellitus and other NCDs, given its simplicity and cost-effectiveness.

Comments:

1. In the Ethics Statement section, the author should specify whether the study was conducted in accordance with the `Helsinki Declaration`.

2. The term "METS-IR" should be written out in full the first time it appears, as should "NHANES."

Reviewer #2: In this study the authors aimed to determine the association between insulin resistance score (MET-IR) and T2DM. The author conclude that a significant association exist between MET-IR and T2DM both in crude and adjusted models. They used systematically acquired survey data, employed appropriate and robust methods and statistics to address their research question, and have presented their results with clarity and scientific soundness.

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Reviewer #1: Yes: Ikunda Dionis

Reviewer #2: Yes: Fredirick mashili

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Association of METS-IR Index with Type 2 Diabetes: A Cross-sectional Analysis of National Health and Nutrition Examination Survey Data from 2009 to 2018

PONE-D-24-31087R1

Dear Dr. Han,

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,

Fredirick Lazaro mashili, MD, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

All the comments have been sufficiently addressed.

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 #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 #1: Yes

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

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 #1: Yes

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 #1: Yes

Reviewer #2: 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: The manuscript is well-written, and the authors have thoroughly addressed all the comments. The study is original, with METS-IR demonstrating potential as a promising, cost-effective, and user-friendly tool for predicting diabetes mellitus. However, the findings related to racial variability require further investigation across different racial groups to draw more conclusive results.

Reviewer #2: All comments have been sufficiently addressed. The authors have provided all what was asked by the reviewers.

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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: Ikunda Dionis

Reviewer #2: Yes: Fredirick mashili

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