Insulin Adjustments for Hospitalized COVID-19 Patients on a Fixed Dexamethasone Protocol
Round 1
Reviewer 1 Report
This paper is extremely well written. The intricacies of a study on COVID-19 in patients with diabetes hold profound relevance in the current medical landscape. Diabetes, as a prevalent chronic condition, significantly impacts the body's immune response and overall health. When intertwined with the complexities of a viral infection like COVID-19, the consequences can be particularly severe. Understanding how patients with COVID19 and diabetes on the Dexamethasone protocol should be initiated on insulin to achieve glycemic control is crucial for tailoring effective treatment strategies, predicting outcomes, and implementing preventive measures. Moreover, such insights contribute to refining public health policies, guiding clinical management, and fostering advancements in both diabetes and COVID-19 research realms. Therefore, delving into the specifics of this study offers invaluable insights that can potentially save lives and alleviate the burden of disease in vulnerable populations.
The paper is well written in every section.
Congratulations to the authors on a remarkably timely and relevant paper. The thoroughness and clarity with which you've presented your findings demonstrate a commendable level of expertise and dedication to the subject matter. Despite a few minor typos, and sometimes the insertion of references later rather than sooner, the overall quality of the writing and meticulous attention to detail, is exemplary, making it a pleasure to read and comprehend. Once again, congratulations to the authors for producing an exceptionally pertinent and timely contribution to the field.
Author Response
Thank you for the feedback and we appreciate your support of our paper. The study results will definitely contribute to better management of diabetes in COVID19 patients.
You mentioned a few minor typos and references that were inserted later than sooner. Do you mind highlighting these for us so that we can correct it for publication purposes.
Reviewer 2 Report
After a thorough review of the attached research paper, it's evident that the study provides a valuable contribution to understanding insulin adjustments for hospitalized COVID-19 patients on dexamethasone. The research methodology is robust, employing a retrospective cohort study design that carefully outlines inclusion criteria and analyzes the impact of dexamethasone on insulin requirements. The study's findings, suggesting the need for initiating diabetic COVID-19 patients on dexamethasone with a higher insulin dosage (0.6-0.7u/kg), are noteworthy and contribute to the growing body of knowledge on managing diabetes in the context of COVID-19 treatment protocols.
Introduction (Lines 40-48): A mechanistic diagram would increase the impact of paper and better undestanding.
Methodology and Study Design (Lines 78-96): The study's retrospective cohort design and the rigorous criteria for inclusion and exclusion of patients provide a solid foundation for the research. However, including a comparison group of diabetic COVID-19 patients not treated with dexamethasone would strengthen the conclusions by providing a baseline for evaluating the specific impact of dexamethasone on insulin requirements.
Data Collection and Analysis (Lines 204-206): The admission of not having a control group is a significant limitation. Future studies should consider including such a group to provide a more robust analysis of the impact of dexamethasone on insulin requirements. Additionally, a more detailed discussion on how confounding factors were controlled or accounted for in the analysis would enhance the credibility of the findings.
Results Interpretation (Lines 190-200): The findings that patients on dexamethasone require higher insulin doses for glycemic control are compelling. It's commendable that the paper discusses the broader implications of these findings for clinical practice. Expanding on how these results compare with existing literature, particularly in light of the variability in insulin sensitivity among patients, would provide valuable context for interpreting these findings.
Limitations and Future Research Directions (Lines 200-220): The acknowledgment of the study's limitations is appreciated, particularly the absence of a control group. Suggesting future research directions, such as prospective studies or exploring the physiological mechanisms behind increased insulin needs in dexamethasone-treated patients, would be beneficial. Highlighting these areas could guide future research efforts and encourage a deeper understanding of managing diabetes in hospitalized COVID-19 patients.
Clinical Implications (Lines 160-176): The discussion on the clinical implications of the study's findings is insightful, especially the proposed adjustments to insulin dosing protocols for hospitalized COVID-19 patients on dexamethasone. Further elaboration on how these recommendations can be integrated into existing clinical guidelines or practice would be valuable for readers, including potential challenges and considerations for implementation.
Overall, the paper makes a significant contribution to understanding insulin management in hospitalized COVID-19 patients on dexamethasone. Addressing the aforementioned points in future revisions or follow-up studies would further enhance the impact and applicability of the research findings.
After a thorough review of the attached research paper, it's evident that the study provides a valuable contribution to understanding insulin adjustments for hospitalized COVID-19 patients on dexamethasone. The research methodology is robust, employing a retrospective cohort study design that carefully outlines inclusion criteria and analyzes the impact of dexamethasone on insulin requirements. The study's findings, suggesting the need for initiating diabetic COVID-19 patients on dexamethasone with a higher insulin dosage (0.6-0.7u/kg), are noteworthy and contribute to the growing body of knowledge on managing diabetes in the context of COVID-19 treatment protocols.
Introduction (Lines 40-48): A mechanistic diagram would increase the impact of paper and better undestanding.
Methodology and Study Design (Lines 78-96): The study's retrospective cohort design and the rigorous criteria for inclusion and exclusion of patients provide a solid foundation for the research. However, including a comparison group of diabetic COVID-19 patients not treated with dexamethasone would strengthen the conclusions by providing a baseline for evaluating the specific impact of dexamethasone on insulin requirements.
Data Collection and Analysis (Lines 204-206): The admission of not having a control group is a significant limitation. Future studies should consider including such a group to provide a more robust analysis of the impact of dexamethasone on insulin requirements. Additionally, a more detailed discussion on how confounding factors were controlled or accounted for in the analysis would enhance the credibility of the findings.
Results Interpretation (Lines 190-200): The findings that patients on dexamethasone require higher insulin doses for glycemic control are compelling. It's commendable that the paper discusses the broader implications of these findings for clinical practice. Expanding on how these results compare with existing literature, particularly in light of the variability in insulin sensitivity among patients, would provide valuable context for interpreting these findings.
Limitations and Future Research Directions (Lines 200-220): The acknowledgment of the study's limitations is appreciated, particularly the absence of a control group. Suggesting future research directions, such as prospective studies or exploring the physiological mechanisms behind increased insulin needs in dexamethasone-treated patients, would be beneficial. Highlighting these areas could guide future research efforts and encourage a deeper understanding of managing diabetes in hospitalized COVID-19 patients.
Clinical Implications (Lines 160-176): The discussion on the clinical implications of the study's findings is insightful, especially the proposed adjustments to insulin dosing protocols for hospitalized COVID-19 patients on dexamethasone. Further elaboration on how these recommendations can be integrated into existing clinical guidelines or practice would be valuable for readers, including potential challenges and considerations for implementation.
Overall, the paper makes a significant contribution to understanding insulin management in hospitalized COVID-19 patients on dexamethasone. Addressing the aforementioned points in future revisions or follow-up studies would further enhance the impact and applicability of the research findings.
Author Response
Introduction (Lines 40-48): A mechanistic diagram is created and inserted.
Methodology and Study Design (Lines 78-96): We expanded the discussion section and explained why it's not the purpose of the study to include a control group but how future studies including a control group would be beneficial in providing a more robust analysis of the impact of dexamethasone on insulin requirements.
Data Collection and Analysis (Lines 204-206): We explained further in the discussion section that how creating a prospective randomized controlled trial with a control group would decrease the effect of confounding factors.
Results Interpretation (Lines 190-200): Study's findings are already compared to multiple existing literature (ex. a study by Brooks D, et al. and a study by Spanakis, et al.).
Limitations and Future Research Directions (Lines 200-220): Several additional suggestions are made in regards to future research directions in the discussion section.
Clinical Implications (Lines 160-176): Further elaboration is made on how the study's findings can be integrated into existing clinical guidelines for implementation.
Thank you reviewer, for your detailed feedback and comments.
Reviewer 3 Report
The methodology matches with the hypothesis, results and discussion
The methodology matches with the hypothesis, results and discussion
Author Response
Thank you for your time and consideration in reviewing this study.
Reviewer 4 Report
In this manuscript, the authors aim to establish a new insulin protocol for diabetic patients with COVID-19 on the dexamethasone protocol for better glycemic control. The manuscript is overall well written and I recommend the following points for revision before acceptance.
1. In line 83-84, the authors state that the review ”resulted in a sample size of 721 patients. We conducted a chart review of all cases to identify patients who met the inclusion criteria.” It will be good if the authors can provide a chart (figure) to show how the 721 patients were reduced to 145 via exclusion and inclusion criteria.
2. It will be good to briefly discuss if there are other suggested protocols for glycemic control for the same situation in the manuscript.
3. It is also good to briefly discuss how COVID affects glycemic control in patients in the introduction or discussion section.
Please see above.
Author Response
- Inclusion/exclusion criteria flow diagram is created and inserted.
- Other suggested protocols for glycemic control for the same situation is already explored in the introduction section, with a UK and Saudi Arabia literature
- It is already explained in the introduction section how COVID affects glycemic control in patients, and mechanistic diagram is also created and inserted for better understanding.
Thank you for the feedback and comments.
