Diabetes management cascade in Ulaanbaatar, Mongolia

Orkhonselenge Davaadamdin; Bolor-Erdene Ganbat; Uurtsaikh Baatarsuren; Khulan Tuvdendarjaa; Maral Myanganbayar; Delgerbat Boldbaatar; Yanfang Su; Andreas Bungert; Myagmartseren Dashtseren; Tsolmon Unurjargal; Johannes Boch; Naranbaatar Dashdorj; Naranjargal Dashdorj

doi:10.1371/journal.pone.0337413

Peer Review History

Original SubmissionMarch 12, 2025
7 Apr 2025 Decision Letter - Patricia Khashayar, Editor Dear Dr. Dashdorj, 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 May 22 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. 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, Patricia Khashayar Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please note that your Data Availability Statement is currently missing the repository name and the DOI/accession number of each dataset or a direct link to access each database. If your manuscript is accepted for publication, you will be asked to provide these details on a very short timeline. We therefore suggest that you provide this information now, though we will not hold up the peer review process if you are unable. 3. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. Additional Editor Comments: The main concern was regarding the method section, so more focus should be directed towards that section [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: I Don't Know ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Line 58, While IFG is a criterion for diagnosing, it's not synonymous with diabetes itself (which can also be diagnosed via HbA1c as well). It would be better to include the exact definition and cut-off points of diabetes from STEPS. Line 62, the KAP survey data is from 2010. While it highlights a historical lack of awareness, it is dated. If more recent studies are available, please include and cite them as well. If not, briefly acknowledge the age of this study while stating it is the best available indicator of past awareness levels. Line 96, “For the laboratory analysis, one in two of the selected participants aged were recruited” Please specify the exact age range subjected to this selection for lab tests and provide some explanation about how the one in two were selected. Was it random or based on other criteria? Line 151, Specify if any standard population structure were used to standardize the prevalence (WHO standard population etc.) Table3, “parity” section seems incorrect considering the subheadings area marital status. Line 400, fix "the with the overall minimal presence" Line 407, Could you briefly explain in the manuscript on why these supply-side gaps might exist in the Mongolian context. Is it lack of specific national guidelines for diabetes management in primary care? Limited resources for training primary care physicians? Issues with laboratory access/standardization for monitoring (relevant given the HbA1c limitation discussion)? Lack of integrated health information systems? Reviewer #2: Good paper with enough information. However there are some points needed to modify. Introduction: the paragraphs are not related to each other. Please make them in better order with relation sentences at the end of the each paragraph. Method: it is not clear what do you want to do. Please explain more about the method section. Result: I think this section is not in good order. Please clarify the outcome measures and explain the results in appropriate way. Discussion: I did not see the strength and limitation of your study. ****** 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 #2: Yes: Laleh Abadi marand ******** [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. https://doi.org/10.1371/journal.pone.0337413.r001
Revision 1
21 May 2025 Author Response Dear Editors, Thank you for the opportunity to revise our manuscript and for the thoughtful and constructive comments provided by the reviewers. We appreciate the time and effort invested in evaluating our work. We have carefully considered all the comments and revised the manuscript accordingly. In rebuttal letter, we provide a detailed, point-by-point response to each comment. Attachments Attachment Submitted filename: Rebuttal letter .pdf https://doi.org/10.1371/journal.pone.0337413.r002
14 Aug 2025 Decision Letter - Patricia Khashayar, Editor Dear Dr. Dashdorj, 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. 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 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, Patricia Khashayar Academic Editor PLOS ONE Journal Requirements: 1. If the reviewer comments include a recommendation to cite specific previously published works, please review and evaluate these publications to determine whether they are relevant and should be cited. There is no requirement to cite these works unless the editor has indicated otherwise. 2. 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. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #3: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> 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 Reviewer #3: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #3: Yes ****** Reviewer #3: Clarify the Discussion Section: Add a brief note comparing your findings to similar published work (if available) to strengthen context. Include more explicit acknowledgment of study limitations (e.g., sample size, potential selection bias). Language Improvements: In the abstract and results, avoid redundancy (e.g., “increase in levels was increased”). Rephrase slightly awkward sentences in the conclusion to improve flow and clarity. Figures and Tables: Ensure all figure legends are self-explanatory. Abbreviations should be defined at first use within tables and figures. Once these minor issues are addressed, I believe the manuscript will be ready for publication. ****** 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 ******** [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 https://doi.org/10.1371/journal.pone.0337413.r003
Revision 2
23 Oct 2025 Author Response Academic Editor PLOS One Re: Manuscript ID /PONE-D-24-39264/ Diabetes management cascade in Ulaanbaatar, Mongolia Dear Editors, Thank you for the opportunity to revise our manuscript and for the thoughtful and constructive comments provided by the reviewers. We appreciate the time and effort invested in evaluating our work. We have carefully considered all the comments and revised the manuscript accordingly. Below, we provide a detailed, point-by-point response to each comment. For clarity, we have included the reviewer/editor comments in bold, followed by our responses in plain text. All changes made in the manuscript have been highlighted in the revised version with tracked changes. Reviewer Comments: Comment: Add a brief note comparing your findings to similar published work (if available) to strengthen context. Response: We have expanded the Discussion section to include a comparison of our results with recent studies on diabetes prevalence and risk factors in similar populations. This provides greater context and highlights consistencies and differences with previous research. Comment: Include more explicit acknowledgment of study limitations (e.g., sample size, potential selection bias). Response: We have added a dedicated paragraph in the Discussion section explicitly outlining the study limitations, including the moderate sample size and potential selection bias due to recruitment methods. These acknowledgments emphasize the need for cautious interpretation and suggest directions for future research. Comment: “Ensure all figure legends are self-explanatory.” Response: We have revised all figure legends to be fully self-explanatory. Each legend now clearly describes the content of the figure, including sample sizes, variables measured, units, and any abbreviations used, so that the figures can be understood independently of the main text. Comment: Abbreviations should be defined at first use within tables and figures. Response: We have defined all abbreviations at their first appearance within tables and figures, either in the legend or footnotes, for clarity and reader convenience. Comment: In the abstract and results, avoid redundancy (e.g., “increase in levels was increased”). Response: We carefully reviewed the manuscript and rephrased redundant expressions to improve clarity and conciseness, including in the Abstract and Results sections. Sincerely Yours, Naranjargal Dashdorj, Chief Executive Officer Phone: +976 99199246 Email: dashdorj@onomfoundation.org Attachments Attachment Submitted filename: Rebuttal_letter__auresp_2.pdf https://doi.org/10.1371/journal.pone.0337413.r004
10 Nov 2025 Decision Letter - Patricia Khashayar, Editor Diabetes management cascade in Ulaanbaatar, Mongolia PONE-D-24-39264R2 Dear Dr. Dashdorj, 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. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support . 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, Patricia Khashayar Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0337413.r005
Formally Accepted
Acceptance Letter - Patricia Khashayar, Editor PONE-D-24-39264R2 PLOS One Dear Dr. Dashdorj, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS One. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. You will receive an invoice from PLOS for your publication fee after your manuscript has reached the completed accept phase. If you receive an email requesting payment before acceptance or for any other service, this may be a phishing scheme. Learn how to identify phishing emails and protect your accounts at https://explore.plos.org/phishing. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Patricia Khashayar Academic Editor PLOS One https://doi.org/10.1371/journal.pone.0337413.r006

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .