PONE-D-24-34100Investigating the Application of IoT Mobile App and Healthcare Services for Diabetic Elderly: A Systematic ReviewPLOS ONE

Dear Dr. Li,

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Muhammad Zulkifl Hasan, PhD

Academic Editor

PLOS ONE

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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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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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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: The manuscript titled "Investigating the Application of IoT Mobile App and Healthcare Services for Diabetic Elderly: A Systematic Review" effectively addresses a critical health issue but has some notable weaknesses. Firstly, the scope of the study is somewhat limited by the relatively small sample size of 18 articles reviewed. This constraint restricts the generalizability of the findings, as the study only captures a narrow snapshot of the available literature on IoT mobile applications in healthcare for the diabetic elderly. Moreover, the study primarily focuses on positive outcomes, while not giving sufficient attention to more granular aspects of the challenges, particularly those beyond technical interoperability and data security issues.

Secondly, the methodology employed for selecting and reviewing the articles could have been more rigorous. Although the paper mentions the use of CASP's Quality Appraisal Tool, it does not provide detailed insights into how each study was critically evaluated. This omission weakens the reliability of the quality assessment, leaving readers with limited understanding of the varying quality of the studies included. Additionally, while the discussion highlights key challenges such as data privacy and usability issues for elderly patients, it lacks depth in exploring how these challenges can be systematically addressed through future research and implementation.

Reviewer #2: The manuscript "Investigating the Application of IoT Mobile App and Healthcare Services for Diabetic Elderly: A Systematic Review" offers valuable insights into the use of IoT mobile applications for managing diabetes in elderly populations. However, the paper exhibits several weaknesses that need to be addressed to improve its clarity and impact. First, while the authors highlight the potential of IoT technologies, the paper lacks depth in terms of real-world case studies or concrete examples demonstrating the successful implementation of these technologies in diabetic care. The lack of empirical data makes it difficult to evaluate the practical applicability of the findings. Adding specific case studies or implementation results would strengthen the claims and provide a more well-rounded discussion.

Additionally, the review touches on various challenges such as interoperability, user adoption, and data security, but these issues are discussed superficially. There is little detailed exploration of how these challenges can be addressed, or the role of healthcare professionals and policymakers in overcoming them. To improve the manuscript, the authors should delve deeper into potential solutions or frameworks for tackling these barriers, such as designing user-friendly interfaces for elderly patients or ensuring regulatory compliance for data protection. A more structured approach to discussing these challenges would offer greater practical value and make the findings more actionable for stakeholders in the healthcare industry.

Lastly, the selection criteria for articles in the systematic review are not clearly justified. While the paper provides some information about the databases used and the inclusion criteria, it would benefit from a more rigorous explanation of why certain studies were selected and how their findings were synthesized. The lack of a critical appraisal of the studies weakens the review's overall credibility. Incorporating a stronger methodology section that outlines the study quality and relevance of the included articles would enhance the reliability of the conclusions drawn in the manuscript.

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Reviewer #1: Yes:  Muhammad Zunnurain Hussain

Reviewer #2: No

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PONE-D-24-34100R1Investigating the Application of IoT Mobile App and Healthcare Services for Diabetic Elderly: A Systematic ReviewPLOS ONE

Dear Dr. Li,

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. Authors are instructed to look for the queries raised by the reviewer for the further round of the consideration.

Please submit your revised manuscript by Mar 03 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,

Vishal Sorathiya

Academic 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.

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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: (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 #1: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #3: N/A

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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 #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

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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 #1: Thank you for revising your manuscript and addressing the previous feedback. After carefully reviewing the changes, I am pleased to acknowledge that most of the concerns raised have been effectively addressed.

Reviewer #3: 1. Introductions need to improve with recent work on Diabetes/IOT/Diabetes in Elders like; https://doi.org/10.1111/hsc.13522, https://doi.org/10.3389/fpubh.2022.871575, http://dx.doi.org/10.1109/TR.2023.3336330, https://doi.org/10.1109/TIT.2023.3340147

2. The table 2 need to cite, form where or what based this inclusion and exclusion selected.

3. Table 3,4,5, 6; each raw need to cite as per journal style [..]

4. . Li highlighted that elderly patients often lack the technical knowledge to assess the security risks

associated with IoT apps (35). Here Li et. al. should be there in place of Li. Please check the manuscript for such error.

5. User adoption and usability also present considerable challenges. Elderly patients often face

cognitive and physical limitations that can hinder their ability to effectively use IoT technologies.

Future solutions must prioritize designing user-friendly interfaces with simplified device operations,

larger text, and voice commands. Moreover, providing adequate training and support for elderly

patients, as well as healthcare professionals guiding them, is essential to ensure long-term engagement

and motivation. Personalized onboarding experiences, as well as ongoing support, can improve

adoption rates and usage. This paragraph needs to cite, with appropriate support reference.

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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:  Muhammad Zunnurain Hussain

Reviewer #3: No

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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.

Investigating the Application of IoT Mobile App and Healthcare Services for Diabetic Elderly: A Systematic Review

PONE-D-24-34100R2

Dear Dr. Li,

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,

Vishal Sorathiya

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: (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 #3: Yes

**********

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

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 #3: Yes

**********

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

**********

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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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 #3: No

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