The Main Risk Factors in Type 2 Diabetes for Cognitive Dysfunction, Depression, and Psychosocial Problems: A Systematic Review
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsDear Author(s),
I really appreciate your manuscript, which is of great quality.
The aim of the study, which was to analyze which risk factors lead to cognitive impairment, depression and psychosocial problems in type 2 diabetes and what aspects they have in common, is clinically important.
The methodology seems adequate. I would recommend you to describe and organize the methodology paragraph as per PRISMA suggestions in total and to more clearly present inclusion and exclusion criteria, as well as the initials of the authors who performed screening, extraction, etc. Also consider adding the rate of agreement between authors who performed screening and the potential need of a third reviewer.
Results are interesting and clearly presented. I do not have any suggestions regarding the results. If I were you I would only make a statement which you did not perform a meta-analysis in addition to systematic review. E.g. due to wide heterogeneity, not in the scope, etc. Figure 1 should be of better quality.
Conclusion are nicely presented and based on the results obtained. I do not have any suggestions here. This study comprehensively demonstrates that the management of type 2 diabetes, particularly concerning mental health, involves a complex interplay of various risk factors. Common determinants for cognitive impairment, depression, and psychosocial problems include comorbidities, dysglycemia, gender, excessive fear and anxiety, educational level, economic status, and medication usage.
This manuscript nicely demonstrates the need of a holistic and multidisciplinary approach within DM setting.
Compliments to the authors.
Best regards, Peer-reviewer.
Author Response
Response to Reviewer Comments
Thank you very much for taking the time to review this manuscript.
I appreciate your thoughtful and constructive feedback on my work. Your insights have been invaluable, and I am deeply thankful for your guidance. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.
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3. Point-by-point response to Comments and Suggestions for Authors
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Comments 1: The methodology seems adequate. I would recommend you describe and organize the methodology paragraph as per PRISMA suggestions in total and to more clearly present inclusion and exclusion criteria, as well as the initials of the authors who performed screening, extraction, etc. Also consider adding the rate of agreement between authors who performed screening and the potential need of a third reviewer.
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Response 1: Thank you for pointing this out. We agree with this comment. Therefore, we have have revised and structured the methodology section in accordance with the PRISMA guidelines. This revision comprehensively addresses critical criteria such as inclusion and exclusion criteria, as well as detailing the roles of the authors, thereby enhancing the clarity and coherence of the methodology.
1.3 The search strategy section has been updated for greater detail and precision, as reflected in the -manuscript on page 2, lines 77-90 . In section 1.4, which focuses on screening and quality control, I have incorporated extensive enhancements to enrich the depth of the content. This can be found on page 3, lines 102-115 and 116-135 of the document. Additionally, I have introduced a new section dedicated exclusively to data analysis. This section provides a detailed account of the analytical processes and is located on page 4, lines 136-170 of the supplementary material.
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Comments 2: If I were you, I would only make a statement in which you did not perform a meta-analysis in addition to systematic review. E.g. due to wide heterogeneity, not in scope, etc. Figure 1 should be of better quality.
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Response 2: I agree with your recommendation. The notable variation among the studies we reviewed necessitates a prudent interpretation of our results. The diversity in methodologies, participant characteristics, and outcome variables highlights the intricate nature of type 2 diabetes, limiting the extent to which our findings can be generalized. Furthermore, the heterogeneity of the data rendered a meta-analysis impractical, as this method demands a degree of uniformity across the studies for a valid synthesis. These adjustments have been duly made in the manuscript on page 12, lines 439-442. Additionally, Figure 1 has been revised and is now available on page 3, line 95 of the document.
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4. Response to Comments on the Quality of English Language |
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Point 1: |
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Response 1: Academic English was checked and corrected. Certificate issued by MDPI. Attached as an attachment. |
Author Response File: 
Author Response.docx
Reviewer 2 Report
Comments and Suggestions for AuthorsThanks to the authors in choosing an intriguing and a emerging topic in the biomedical research, where metabolic diseases, like diabetes is becoming a serious health issue, due to comorbidities, viz., say for as the neurobehavioral diseases here, complexing the health and to maintain a heathy life. Authors try to put the most and the best knowledge to narrow down the knowledge gap. Besides this quality the manuscript needs to be revised in particular such following measurable action taken, and to be more concise and have to bring some matrix in judging the complexities. The specifics are:
In Introduction:
It needs some more statistics on the verge of comorbidities and the disease itself, that will define the health disparities in those areas.
In Methodology:
Line 46-57: Some unwanted dots are there.
Line 53: PICO-However mentioned later the information should be made in a parenthesis about where it is mentioned.
Line 72; Section 1.3 (Research Strategies): It should be under the methodology and the search strategies. The whole Mythologies section has to be realigned.
Did the authors use any software to the search strategies, and simple manual records findings could be a biased, if so, what to defend about the biasness. The exclusion criterion was mentioned later but should also prominent and run as footnote in each table. Also, the Figure 1 or Table holds the same information. Anyone is fine. I will recommend Figure-1 with strong footnotes.
In Results:
Line 190 & Line 243: The subcategories styles are different. Put them all under same typos and style.
In Discussion:
Overall, the discussion has to be overhauled and revised thoroughly. It should be the reflection of what is found, and others says. It should bear authors own thought processes and what they think as the seminaries in the determining factors (which they stressed more) but more should towards the biological pathways that triggered due to Type 2 diabetes) an thematic connectivity and or pathways diagram is a must, and the reason behind such connection has to be emphasized.
Line 272-273: The sentence structure does not reflect what the authors mean to say. Reda and rewrite.
Section 3.2 and 3.3: Concise these two sections in terms in the realm of Social (S) Determinants (D) of Health (OH). Refer; Social Determinants of Health - Healthy People 2030 | health.gov
Comments on the Quality of English Language
May improve under language editing. Also, too wordy. Include some statistical information as indicated earlier.
Author Response
Response to Reviewer Comments
Thank you very much for taking the time to review this manuscript.
I appreciate your thoughtful and constructive feedback on my work. Your insights have been invaluable, and I am deeply thankful for your guidance. Please find the detailed responses below and the corresponding revisions/corrections highlighted/in track changes in the re-submitted files.
Comments 1:
In Introduction:It needs some more statistics on the verge of comorbidities and the disease itself, that will define the health disparities in those areas.
Response 1: Thank you for pointing this out. We agree with this comment. Based on the literature, static points (percentage values) have been added to the introduction to interpret the proportion. Page 1, lines 34–43
Comments 2: In Methodology:
- Line 46-57: Some unwanted dots are there.
- Line 53: PICO-However mentioned later the information should be made in a parenthesis about where it is mentioned.
- Line 72; Section 1.3 (Research Strategies): It should be under the methodology and the search strategies. The whole Mythologies section has to be realigned.
- Did the authors use any software to the search strategies, and simple manual records findings could be a biased, if so, what to defend about the biasness. The exclusion criterion was mentioned later but should also prominent and run as footnote in each table. Also, the Figure 1 or Table holds the same information. Anyone is fine. I will recommend Figure-1 with strong footnotes.
Response 2: Agree.
Redundancies in the text have been eliminated. The full definition of PICO is clearly presented on page 2, line 57. The methodology section has undergone significant expansion, with new paragraphs added for comprehensiveness. This section has been developed in alignment with the PRISMA checklist to ensure thorough coverage of all necessary components. The detailed methodology can be found spanning pages 2 to 4, lines 52-136. Enhancements addressing bias mitigation are noted on lines 115-129. Additionally, Table 1 has been revised, and a corresponding explanatory footnote has been incorporated.
Comments 3:
In Results:
Line 190 & Line 243: The subcategories styles are different. Put them all under same typos and style.
In Discussion:
- Overall, the discussion has to be overhauled and revised thoroughly. It should be the reflection of what is found, and others says. It should bear authors own thought processes and what they think as the seminaries in the determining factors (which they stressed more) but more should towards the biological pathways that triggered due to Type 2 diabetes) an thematic connectivity and or pathways diagram is a must, and the reason behind such connection has to be emphasized.
- Line 272-273: The sentence structure does not reflect what the authors mean to say. Reda and rewrite.
- Section 3.2 and 3.3: Concise these two sections in terms in the realm of Social (S) Determinants (D) of Health (OH). Refer; Social Determinants of Health - Healthy People 2030 | health.gov
Response 3:
We agree with the suggestions and recommendations. The discussion has been updated. Above all, the reflection of the results was emphasized, and it was synthesized. The author's own view is also included. Corrections: page 10 line 344-357, page 12 line 379-391, and page 13 line 428-442. Corrected formatting and sentence wording. Figure 2 has been developed, emphasizing the mental health issues associated with type 2 diabetes and their interconnections.
Thank you for suggesting the incorporation of terms from the Social Determinants of Health in sections 3.2 and 3.3. We believe that this construct aligns more closely with the concept of holistic health, focusing on the impact of social factors on health. Our article, however, specifically addresses individuals with type 2 diabetes, who are at risk of depression, cognitive impairments, and psychosocial challenges. The essence of our work is to demonstrate the significance of mental health-related issues in the context of diabetes.
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4. Response to Comments on the Quality of English Language |
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Point 1: May improve under language editing. Also, too wordy. Include some statistical information as indicated earlier. |
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Response 1: Academic English was checked and corrected. Certificate issued by MDPI. Attached as an attachment. |
Author Response File: Author Response.docx
Reviewer 3 Report
Comments and Suggestions for AuthorsRegarding the main risk factors in type 2 diabetes for cognitive dysfunction, depression, and psychosocial problems, it was presented and listed in detail and clearly in the literature.
-For each table, I think the explanation for each risk factor is a bit too brief. For example, for age, if five references are cited, then five cutoff values should be given for each.
-Regarding sex, does "Woman" and "female sex" represent any difference?
-Regaeding pharmacologic causes, specific risk ratio (e.x. odds ratio) on the extent to which the use of the drug affects the patient should be included.
Author Response
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Response to Reviewer Comments
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1. Summary |
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4. Response to Comments on the Quality of English Language |
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Point 1: no comments |
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Author Response File: Author Response.docx
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsThanks to authors for taking substantial changes that was requested. The manuscript is now very much improved.
