Decoding Diabetes Nutritional Guidelines for Physicians in Underserved American Populations

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

I read the paper entitled “Decoding Diabetes Nutritional Guidelines for Physicians in Underserved American Populations” by Kelly et al. with great interest. I completely agree with the importance of this topic and potential gap in previous research. However, I don’t think the development of this paper meet its aims:

1.      Many sections were general discussions but not related to characteristics of underserved American populations (e.g., section 2.1-2.3, section 3)

2.      The key recommendations in Summary and Conclusion section did not entirely align with those in the manuscript. For example, “In order of preference: fresh fruits and vegetables > frozen > canned” or “Use less dressings, sauces and condiments” were not previously discussed, nor supported by literature references.

3.      Regarding some recommendations discussed in the main body of the manuscript, the authors did not provide adequate evidence or rationale. For example, despite the different carb/sugar content of different alcoholic drinks, studies did not consistently show which alcoholic drink has the highest risk of diabetes or is optimal for glycemic control. Therefore, the recommendation of low carb beer is not well justified.

4.      The target audience of this paper remains unclear. If the readers possess sufficient knowledge to comprehend the recommendations and cited research, Table 2 is unlikely to be useful to them.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This review copes with a practical problem, namely the impossibility of using the official dietary guidelines for the treatment of diabetes in subjects who are in disadvantaged conditions.

The content of the paper is well organized and addresses the main situations that require a differentiated approach.

From my point of view there are no particular critical points, other than the presence of some typing errors.

I congratulate the authors for raising the importance of health care in individuals who have difficulty accessing it.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

The manuscript entitled, ‘Decoding Diabetes Nutritional Guidelines for Physicians in Underserved American Populations’, demonstrates healthcare for underserved people with diabetes and creates awareness including nutritional guidelines and lifestyles for the rural population of the USA. However, there are some concerns that should be addressed by the authors prior to any consideration of this manuscript to be published in the Journal of ‘Endocrines’.

1. Introduction:

-The authors should clarify the novelty of this article in the ‘Introduction’ or ‘Conclusion’ section.

2. How is this literature more informative than the previously published ones? Justify it.

3. The authors should give the pictorial (Schematic diagram) representation to sections 2, 6 & 7 individually for each for the better clarification and betterment of the manuscript.

4. The authors should give the pictorial (Schematic diagram) representation to sections 3, 4 & 5 in one for the better clarification and betterment of the manuscript.

5. The author should include one another section dealing with ongoing advancements and the prospects of role of Healthy Nutrition and life style changes in the management of Diabetes.

6. Authors have to include the limitations and future prospects of their studies

7. The conclusion should focus on the key findings and future implications, without going into too many details.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

I appreciate the revision made by the authors. I have no more suggestions.

Author Response

Dear Reviewer 1:

On behalf of all authors, we thank you for your hard work to help us improve our manuscript. We have reviewed the manuscript and made some additional minor changes. We removed the yellow highlight so the new changes could be seen easily, we used blue highlights this time. Deleted text is not highlighted. We also moved some text around in the Summary.

Regards,

Authors

Reviewer 3 Report

Comments and Suggestions for Authors

The authors have implemented almost all the suggestions. However, I suggest that rather than a lengthy description, a concise summary of key findings would strengthen the conclusion.

Comments on the Quality of English Language

N/A

Author Response

Dear Reviewer 3.

On behalf of all authors, we are grateful for your suggestions. These have strengthened the manuscript and have certainly made it more reader friendly. We have reviewed the manuscript and made some additional minor changes. We removed the yellow highlight so the new changes could be seen easily, we used blue highlights this time. Deleted text is not highlighted. We also moved some text around in the Summary.

Comment: The authors have implemented almost all the suggestions. However, I suggest that rather than a lengthy description, a concise summary of key findings would strengthen the conclusion.

Thank you for your diligent work. We have included the key findings in the conclusion, we had 6 key findings which summarize the entire review. The new conclusion reads as follows: 

In conclusion, the key findings of this review are 1) the current dietary guidelines for diabetes have significant gaps in relation to nutritional therapy in rural and underserved areas, 2) people with diabetes in rural areas are estimated to have a macronutrient distribution similar to those without diabetes, and be within the AMDR, 3) people with diabetes are estimated to consume a diet of poor quality and may be insufficient in micronutrients, 4) supplemental resources to assist the rural physician initiate nutritional therapy were discussed and summarized, 5) cultural preferences must be part of the nutritional therapy approach for rural communities, and 6) there is an urgent need to investigate the nutritional environment of rural communities. The health of rural communities must be addressed, and rural physicians and other rural healthcare professionals must be supported with relevant guidelines and resources.

Regards,

Authors