Glycemia and New-Onset Diabetes among COVID-19 Patients with Prediabetes: A Follow-Study of Case Series in India
Round 1
Reviewer 1 Report
In The manuscript title “Glycemia and New-onset Diabetes among COVID-19 Patients with Prediabetes: A Follow-up Study in India” the authors conducted a prospective study of 69 COVID-19 patients with prediabetes (HbA1c 5.7-6.4%) who were admitted to a 13 tertiary care hospital in Chennai, India, from May to October 2020 and were discharged alive. In order to provide data on longitudinal changes in glycaemic parameters among COVID-19 patients with prediabetes. I recommend the publication after major revision.
1- The authors need to provide a control for this study.
2- Introduction is very short, I recommend, authors add a part about the previous studies regarding the relationship between diabetes and Covid 19. And discuss the whether the new-onset diabetes associated with COVID-19 is type 1, type 2, or a complex subtype of diabetes.
3- In line 75. ( 3.1 Characteristics of patients on admission). The information about how selected the patients and their characteristic should be under material and method. This information doesn’t consider results.
4- Conclusion need to include summary of results with data
Author Response
Attached
Author Response File: 
Author Response.docx
Reviewer 2 Report
In this manuscript, Nirmala and Thirunavukkarasu conducted a prospective cohort study of 69 COVID-19 patients with pre-diabetes in Chennai, India. They found that the mean fasting plasma glucose raised and a large proportion of the patients were discharged with glucose-lowering medications, some of them developed new onset diabetes after recovery. The main defect of this study was the limited patient number of the cohort. Only the primary results have been shown (i.e percentage), which lack of statistical analysis.
Specific points:
1. The patient information should be presented, such as the criteria for inclusion/exclusion, pre-conditions, age distributions, and any bias on patient selection, etc.
2. It is interesting that the plasma glucose increases by ~ 14% (16.8/119 mg/dL), which is greater than that of ~10% increase of HbA1c (0.6/5.9%), how to explain it?
3. The main conclusion of this study is that a large proportion of the patients have higher glucose levels and some of them developed new onset diabetes after recovery. Again, the numbers seem to be great but lack of significance tests.
Author Response
Attached
Author Response File: Author Response.docx
Round 2
Reviewer 1 Report
Accept in present form.
Author Response
Thank you very much.
Reviewer 2 Report
The authors have improved the study and the data has been presented more clear. However, for the comment #1, there is still possibility to obtain bias even all the patients were included, such as hospital/dept specialization, etc. For the comment #3, I couldn't find the statistical results on page 10.
Author Response
1. However, for the comment #1, there is still possibility to obtain bias even all the patients were included, such as hospital/dept specialization, etc.
We have now acknowledged the possibility of a selection bias on Page 13, Para 2, as follows:
First, we studied only patients with moderate to critical illness admitted to the special wards of the hospital, missing out on those with the mild disease treated in the general wards, thereby resulting in a selection bias.
2. For the comment #3, I couldn't find the statistical results on page 10.
We have now included a table on Page 11 showing the results of the mixed-effects linear regression models with 95% CIs and p values. Figure 2 is a graphical representation of Table 3.
