PONE-D-23-41579The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up studyPLOS ONE

Dear Dr. Alemu,

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Wondimeneh Shiferaw

Academic Editor

PLOS ONE

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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: 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: No

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: 1. There are linguistic and editing errors like lack of hyphens, periods, inconsistent capitalization, misspellings, and formatting inconsistencies.

2. Can you provide more specific details on the existing research gap in Ethiopia regarding PAD and vascular complications in type 2 diabetes mellitus patients? How does the proposed study aim to address this gap, and what unique contributions does it offer to the existing literature?

3. You focused your study on type 2 diabetic patients aged 14 years and older. Could you explain why you didn't include children under 14, considering that type 2 diabetes is also affecting younger individuals? Additionally, what's the rationale behind choosing this particular age as the cutoff point?

4. It would be better if the discussion section discusses potential differences in study populations, methodologies, and healthcare systems that may contribute to variations in findings. Additionally, considering factors such as sample size and follow-up duration could provide further context for interpretation.

5. The discussion addresses variations in PAD incidence rates across different studies and attributes the higher incidence rate in this study to differences in case detection methodologies. However, it would be helpful to discuss potential limitations of Doppler ultrasound evaluations in detecting PAD, such as operator dependence and variability in interpretation, and whether alternative diagnostic approaches could provide complementary information.

6. Regarding the predictors identified for PAD development in type 2 DM patients, how could healthcare professionals integrate this information into clinical practice to improve patient care and outcomes?

7. Are there any unique challenges or opportunities in Ethiopia's healthcare system or socio-economic environment that should be considered when interpreting the study findings and implementing interventions?

Reviewer #2: Review report

Manuscript tittle: The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up study Short Title: Incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients

Manuscript Number: PONE-D-23-41579

In the abstract line 40 Result: please write as Results

Being female (AHR=2.18(1.36, 3.51), age 42 above 65 years (AHR=1.66, CI: 1.06, 2.61), and fasting blood sugar of more than 140mg/dl 43 (AHR= 3.34(1.62, 6.90) were predictors for time to peripheral arterial disease in type 2 diabetes 44 mellitus.( Line 42- 44)

Comments: AHR: Please write the entire word (definition) first, followed by its abbreviation in brackets, and then utilize it throughout your write up. Please make the same corrections for the remaining abbreviations in this document.

Please add 95% CI consistently

In the introduction section (line 77)

Some studies have estimated the median times for onset of PAD in type2 diabetes mellitus patients

Comments: type2 correct it as type 2

There are factors which can affect the survival of type 2 DM patients from PAD occurrence. (Line 79)

Comments: DM: Please write the entire word (definition) first, followed by its abbreviation in brackets, and then utilize it throughout your write up. Please make the same corrections for the remaining abbreviations in this document.

The material and methods is Ok, just to delete some redundancy sentences

Comments: Please delete the followings in the material and methods section.

Study design (line 99)

An institution-based retrospective follow-up study was conducted at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia (line 100-101)

Please rewrite as Study design, area and period in line 102

Please add Independent variables as a subtitle after line 153

Results

The cumulative survival to PAD probabilities of T2DM patients after 5, 10 and 15 years were 0.97, 0.76, 0.35 respectively.(Lines 261-262)

Comments: please rewrite the above sentence as The cumulative survival probabilities of PAD among T2DM patients after 5, 10 and 15 years were 0.97, 0.76 and 0.35, respectively.

Please rewrite the sentence in line 280 as (AHR=1.66, 95% CI: 1.06, 2.61) higher as compared to those whose age was ≤65 years.

Discussion

The importance or implication or significance of each result should be stated in the discussion section.

In the Conclusion section do not use figures (numbers) rather conclude the main findings.

Figures 1- 4 needs edition for example analysis time by what? month or year? Clearly state it.

Chi2 please replace it by X2

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Reviewer #1: No

Reviewer #2: Yes:  Tamiru Alene

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PONE-D-23-41579R1The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up studyPLOS ONE

Dear Dr. Alemu,

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.

The manuscript has been evaluated by two reviewers, and their comments are available below.

The reviewers have a couple of minor clarification requests. Could you please revise the manuscript to carefully address the concerns raised?

Please submit your revised manuscript by Mar 15 2025 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:

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• 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,

Helen Howard

Staff Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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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 #1: All comments have been addressed

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 #1: Yes

Reviewer #3: Yes

**********

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

Reviewer #1: Yes

Reviewer #3: 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 #3: 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 #3: 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: Thank you for your revised submission and for carefully addressing the concerns I raised. I appreciate the efforts you have made to improve the manuscript. The revisions have significantly strengthened the clarity and overall quality of the paper.

Reviewer #3: In the abstract – Result sub-section:

“The incidence rate of peripheral arterial disease was high.”

The authors need to specify the reference to conclude high like compare with the recommended value or compare with the previous study or -----

In the result section

The hazard of PAD in female type 2 DM patients was twofold (AHR = 2.18), more

283 than in males. Furthermore, the hazard of PAD among type 2 DM patients with baseline FBS >284 140 mg/dl was 3.3 times higher than those with FBS ≤ 140 mg/dl (AHR = 3.34).

The authors need to include 95%CI.

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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: No

Reviewer #3: Yes:  Esubalew Tesfahun

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PONE-D-23-41579R2

The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up study

PLOS ONE

Dear Dr. Alemu,

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.

Specifically, please note that PLOS ONE does not copyedit manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Please work to improve the quality of the writing throughout your manuscript. We recommend enlisting the help of a professional copyediting service.

Please submit your revised manuscript by Mar 27 2025 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.

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• 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,

Helen Howard

Staff Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments:

- Please work to improve the quality of the writing throughout your manuscript. We recommend enlisting the help of a professional copyediting service.

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[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.]

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PONE-D-23-41579R3The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up studyPLOS ONE

Dear Dr. Alemu,

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.

We understand that the Grammarly tool was used to assist you with this revision, but unfortunately language errors remain throughout the manuscript. The manuscript still requires copyediting in order to improve the English grammar and syntax to a publishable standard. We recommend asking a native English-speaking colleague to assist you or to enlist the help of a professional copyediting service.

Please submit your revised manuscript by Apr 01 2025 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,

Helen Howard

Staff Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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[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.

The incidence and predictors of peripheral arterial disease among type 2 diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2023: a retrospective follow up study

PONE-D-23-41579R4

Dear Dr. Alemu,

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,

Patrick Goymer

Staff Editor

PLOS ONE

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