Reviewer's report
Title:Diabetes and insulin use are linked to Helicobacter pylori eradication
Version: 5Date:24 February 2012
Reviewer: David Whiteman
Reviewer's report:
Diabetes and insulin use are linked to Helicobacter pylori eradication
Chin-Hsiao Tseng
This is an interesting analysis of a population database in Taiwan. The author
has used routine health data (in this case, insurance data) to explore the
relationship between type 2 diabetes and treatment for Helicobacter pylori
infection. They are attempting to infer a causal association from this retrospective
analysis.
A number of issues present themselves when attempting to interpret this paper.
1. Is the question posed by the author well defined? No, the author has not
explicitly stated their research question as a clearly testable hypothesis; rather,
the question is implied in the title and in the Introduction to the study. This is a
MINOR ESSENTIAL REVISION
2. Are the methods appropriate and well described? No. I am not clear that I
understand how exposure and outcome were defined. It is not stated explicitly
whether the intent of the analysis was to constrain H pylori eradication to occur
only AFTER diabetes was diagnosed, or whether it could occur at any time within
the study interval. The former would imply that diabetes preceded H pylori
treatment, and might therefore imply some temporal order. This has major
implications for interpreting the analysis. Most readers would be expecting a
retrospective cohort design, in which the cohort has been defined by date of
assembly, and that the diagnosis of diabetes must precede the date of
eradication of H pylori. Is this what happened? It appears not, and that there is
simply an attempt to assess a cross-sectional association. This is a MAJOR
ESSENTIAL REVISION
3. Are the data sound? The data were obtained from the national health
insurance records of Taiwan. They are likely to be reasonably complete, and are
not likely to be biased with respect to diabetes status or records of H pylori
eradication. However, I suspect that there is considerable under-diagnosis and
under-treatment of H pylori in this population. Some comment from the
investigators is required. This is a MINOR ESSENTIAL REVISION
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition? Yes.
5. Are the discussion and conclusions well balanced and adequately supported
by the data? Yes.
6. Are limitations of the work clearly stated? Yes
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished? Yes.
8. Do the title and abstract accurately convey what has been found? Yes
9. Is the writing acceptable? Yes.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Reviewer's report
Title:Diabetes and insulin use are linked to Helicobacter pylori eradication
Version: 5Date:24 February 2012
Reviewer: David Whiteman
Reviewer's report:
Diabetes and insulin use are linked to Helicobacter pylori eradication
Chin-Hsiao Tseng
This is an interesting analysis of a population database in Taiwan. The author
has used routine health data (in this case, insurance data) to explore the
relationship between type 2 diabetes and treatment for Helicobacter pylori
infection. They are attempting to infer a causal association from this retrospective
analysis.
A number of issues present themselves when attempting to interpret this paper.
1. Is the question posed by the author well defined? No, the author has not
explicitly stated their research question as a clearly testable hypothesis; rather,
the question is implied in the title and in the Introduction to the study. This is a
MINOR ESSENTIAL REVISION
2. Are the methods appropriate and well described? No. I am not clear that I
understand how exposure and outcome were defined. It is not stated explicitly
whether the intent of the analysis was to constrain H pylori eradication to occur
only AFTER diabetes was diagnosed, or whether it could occur at any time within
the study interval. The former would imply that diabetes preceded H pylori
treatment, and might therefore imply some temporal order. This has major
implications for interpreting the analysis. Most readers would be expecting a
retrospective cohort design, in which the cohort has been defined by date of
assembly, and that the diagnosis of diabetes must precede the date of
eradication of H pylori. Is this what happened? It appears not, and that there is
simply an attempt to assess a cross-sectional association. This is a MAJOR
ESSENTIAL REVISION
3. Are the data sound? The data were obtained from the national health
insurance records of Taiwan. They are likely to be reasonably complete, and are
not likely to be biased with respect to diabetes status or records of H pylori
eradication. However, I suspect that there is considerable under-diagnosis and
under-treatment of H pylori in this population. Some comment from the
investigators is required. This is a MINOR ESSENTIAL REVISION
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition? Yes.
5. Are the discussion and conclusions well balanced and adequately supported
by the data? Yes.
6. Are limitations of the work clearly stated? Yes
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished? Yes.
8. Do the title and abstract accurately convey what has been found? Yes
9. Is the writing acceptable? Yes.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
Please review this paper.
user
Reviewer's report
Title:Diabetes and insulin use are linked to Helicobacter pylori eradication
Version: 5Date:24 February 2012
Reviewer: David Whiteman
Reviewer's report:
Diabetes and insulin use are linked to Helicobacter pylori eradication
Chin-Hsiao Tseng
This is an interesting analysis of a population database in Taiwan. The author
has used routine health data (in this case, insurance data) to explore the
relationship between type 2 diabetes and treatment for Helicobacter pylori
infection. They are attempting to infer a causal association from this retrospective
analysis.
A number of issues present themselves when attempting to interpret this paper.
1. Is the question posed by the author well defined? No, the author has not
explicitly stated their research question as a clearly testable hypothesis; rather,
the question is implied in the title and in the Introduction to the study. This is a
MINOR ESSENTIAL REVISION
2. Are the methods appropriate and well described? No. I am not clear that I
understand how exposure and outcome were defined. It is not stated explicitly
whether the intent of the analysis was to constrain H pylori eradication to occur
only AFTER diabetes was diagnosed, or whether it could occur at any time within
the study interval. The former would imply that diabetes preceded H pylori
treatment, and might therefore imply some temporal order. This has major
implications for interpreting the analysis. Most readers would be expecting a
retrospective cohort design, in which the cohort has been defined by date of
assembly, and that the diagnosis of diabetes must precede the date of
eradication of H pylori. Is this what happened? It appears not, and that there is
simply an attempt to assess a cross-sectional association. This is a MAJOR
ESSENTIAL REVISION
3. Are the data sound? The data were obtained from the national health
insurance records of Taiwan. They are likely to be reasonably complete, and are
not likely to be biased with respect to diabetes status or records of H pylori
eradication. However, I suspect that there is considerable under-diagnosis and
under-treatment of H pylori in this population. Some comment from the
investigators is required. This is a MINOR ESSENTIAL REVISION
4. Does the manuscript adhere to the relevant standards for reporting and data
deposition? Yes.
5. Are the discussion and conclusions well balanced and adequately supported
by the data? Yes.
6. Are limitations of the work clearly stated? Yes
7. Do the authors clearly acknowledge any work upon which they are building,
both published and unpublished? Yes.
8. Do the title and abstract accurately convey what has been found? Yes
9. Is the writing acceptable? Yes.
Level of interest: An article whose findings are important to those with closely
related research interests
Quality of written English: Acceptable
Statistical review: Yes, and I have assessed the statistics in my report.
assistant