Reviewer's report
Title:Identifying patients with chronic hepatitis B at high risk of type 2 diabetes
mellitus: a case-control study
Version:4Date:3 January 2015
Reviewer: Harkirat Singh
Reviewer's report:
Major Revisions.
1. Study Population and Data Collection- were these patients treatment naive for
Anti HBV drugs or not? Were any of the patients currently on treatment? Were
any non responders? Please clarify the treatment status of the included patients.
2. How was the diagnosis of alcoholic steatosis obtained? AS mentioned in the
text, steatosis was diagnosed on imaging - US or CT. How was it called alcoholic
vs non alcoholic? Based on amount of drinking? Please clarify. As there could be
a subset of people with non alcoholic steatosis, which would mean many parts in
the manuscript relating to alcoholic steatosis will need modification.
3. In results - "In addition, mean creatinine levels were higher in patients of the
case group than those from the control group, suggesting that diabetic CHB
patients may have early kidney impairment.". What was the range of normal cr? I
think its better to give percentages of people with elevated cr (~ckd) and then
analysing rather than mean cr. E.g. if range is like 0.6-1.0, then a mean of 0.6 vs
0.9 may seem significant but both 0.6 and 0.9 are in normal range so cannot say
one is worse than the other.
4. In discussion, please mention the biases of case control studies in a little more
detail and in the context of this study rather than just saying "This is a
case-control study, which is the most important limitation of our work. Thus, we
cannot establish a firm cause-effect relationship between risk factors identified,
their interactions and T2DM."
5. In Table 2, please mention the normal ranges for these labs.
Minor Revisions.
1. In the abstract, results - "three typical features of CHB" - please remove the
word "typical".
2. In the abstract, results - last line - "and" should come before "presence of
alcoholic steatosis" and not before GGT levels.
3. In the abstract, conclusions - "Our findings suggest that high viral load, long
duration of CHB, presence of cirrhosis, alcoholic steatosis and several other
factors may risk factors for T2DM development." This should read as follows "Our
findings suggest that high viral load, long duration of CHB, presence of cirrhosis,
alcoholic steatosis and several other factors may be potential risk factors for
development of T2DM in CHB patients"
4. In results, clinical and lab features -"The case group did not differ obviously in
the percentage of HCC from the control group". Please remove the word
obviously.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Reviewer's report
Title:Identifying patients with chronic hepatitis B at high risk of type 2 diabetes
mellitus: a case-control study
Version:4Date:3 January 2015
Reviewer: Harkirat Singh
Reviewer's report:
Major Revisions.
1. Study Population and Data Collection- were these patients treatment naive for
Anti HBV drugs or not? Were any of the patients currently on treatment? Were
any non responders? Please clarify the treatment status of the included patients.
2. How was the diagnosis of alcoholic steatosis obtained? AS mentioned in the
text, steatosis was diagnosed on imaging - US or CT. How was it called alcoholic
vs non alcoholic? Based on amount of drinking? Please clarify. As there could be
a subset of people with non alcoholic steatosis, which would mean many parts in
the manuscript relating to alcoholic steatosis will need modification.
3. In results - "In addition, mean creatinine levels were higher in patients of the
case group than those from the control group, suggesting that diabetic CHB
patients may have early kidney impairment.". What was the range of normal cr? I
think its better to give percentages of people with elevated cr (~ckd) and then
analysing rather than mean cr. E.g. if range is like 0.6-1.0, then a mean of 0.6 vs
0.9 may seem significant but both 0.6 and 0.9 are in normal range so cannot say
one is worse than the other.
4. In discussion, please mention the biases of case control studies in a little more
detail and in the context of this study rather than just saying "This is a
case-control study, which is the most important limitation of our work. Thus, we
cannot establish a firm cause-effect relationship between risk factors identified,
their interactions and T2DM."
5. In Table 2, please mention the normal ranges for these labs.
Minor Revisions.
1. In the abstract, results - "three typical features of CHB" - please remove the
word "typical".
2. In the abstract, results - last line - "and" should come before "presence of
alcoholic steatosis" and not before GGT levels.
3. In the abstract, conclusions - "Our findings suggest that high viral load, long
duration of CHB, presence of cirrhosis, alcoholic steatosis and several other
factors may risk factors for T2DM development." This should read as follows "Our
findings suggest that high viral load, long duration of CHB, presence of cirrhosis,
alcoholic steatosis and several other factors may be potential risk factors for
development of T2DM in CHB patients"
4. In results, clinical and lab features -"The case group did not differ obviously in
the percentage of HCC from the control group". Please remove the word
obviously.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
Please review this paper.
user
Reviewer's report
Title:Identifying patients with chronic hepatitis B at high risk of type 2 diabetes
mellitus: a case-control study
Version:4Date:3 January 2015
Reviewer: Harkirat Singh
Reviewer's report:
Major Revisions.
1. Study Population and Data Collection- were these patients treatment naive for
Anti HBV drugs or not? Were any of the patients currently on treatment? Were
any non responders? Please clarify the treatment status of the included patients.
2. How was the diagnosis of alcoholic steatosis obtained? AS mentioned in the
text, steatosis was diagnosed on imaging - US or CT. How was it called alcoholic
vs non alcoholic? Based on amount of drinking? Please clarify. As there could be
a subset of people with non alcoholic steatosis, which would mean many parts in
the manuscript relating to alcoholic steatosis will need modification.
3. In results - "In addition, mean creatinine levels were higher in patients of the
case group than those from the control group, suggesting that diabetic CHB
patients may have early kidney impairment.". What was the range of normal cr? I
think its better to give percentages of people with elevated cr (~ckd) and then
analysing rather than mean cr. E.g. if range is like 0.6-1.0, then a mean of 0.6 vs
0.9 may seem significant but both 0.6 and 0.9 are in normal range so cannot say
one is worse than the other.
4. In discussion, please mention the biases of case control studies in a little more
detail and in the context of this study rather than just saying "This is a
case-control study, which is the most important limitation of our work. Thus, we
cannot establish a firm cause-effect relationship between risk factors identified,
their interactions and T2DM."
5. In Table 2, please mention the normal ranges for these labs.
Minor Revisions.
1. In the abstract, results - "three typical features of CHB" - please remove the
word "typical".
2. In the abstract, results - last line - "and" should come before "presence of
alcoholic steatosis" and not before GGT levels.
3. In the abstract, conclusions - "Our findings suggest that high viral load, long
duration of CHB, presence of cirrhosis, alcoholic steatosis and several other
factors may risk factors for T2DM development." This should read as follows "Our
findings suggest that high viral load, long duration of CHB, presence of cirrhosis,
alcoholic steatosis and several other factors may be potential risk factors for
development of T2DM in CHB patients"
4. In results, clinical and lab features -"The case group did not differ obviously in
the percentage of HCC from the control group". Please remove the word
obviously.
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: Yes, but I do not feel adequately qualified to assess the
statistics.
Declaration of competing interests:
I declare that I have no competing interests
assistant