Glycaemic Variability and Hyperglycaemia as Prognostic Markers of Major Cardiovascular Events in Diabetic Patients Hospitalised in Cardiology Intensive Care Unit for Acute Heart Failure
, Ambroise Bouchard de La Poterie 1, Thomas Baudinet 1, Michel Montaudon 2, Marie-Christine Beauvieux 3,4, Anne-Iris Lemaître 5, Laura Cetran 1, Benjamin Seguy 1, François Picard 5, Fritz-Line Vélayoudom 6,7, Alexandre Ouattara 8,9, Rémi Kabore 10, Pierre Coste 1,2, Pierre Domingues-Dos-Santos 2,5,11 and Bogdan Catargi 12Round 1
Reviewer 1 Report
This article is very interesting. I think it is appropiated for publication in JCM.
Author Response
Please see the attachment.
Author Response File: 
Author Response.docx
Reviewer 2 Report
The manuscript by Gerbaud et al. is an observational study on the prognostic value of glycemic variability in acute heart failure mid-term outcomes. I commend the Authors for their nice work and my comments are mostly minor.
- Line 52,53. I would specify what type of association you referred to (e.g., positive association with poor outcomes, inverse relationship etc.)
- Line 59-60 Please specify that you referred to diabetes-associated complications
- Line 62-64 Please rephrase the explanation on the studies you mentioned since it is unclear and not very readable. I would also move this section in the discussion
- Please be consistent throughout the text with the units of measure (e.g., glucose sometimes is expressed by mmol/L only, sometimes with mg/dl and (mmol/L).
- Since you do not only analyze glycemic variability, I would probably use a more general title (e.g., Hyperglycemia and glycemic variability as prognostic markers of MACE in diabetic patients hospitalized in Cardiology Intensive Care Unit for Acute heart failure”
Author Response
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Author Response File: Author Response.docx
Reviewer 3 Report
The authors examined 392 consecutive cases with diabetes and acute heart failure (AHF), and showed glycemic variability (GV) was an independent predictive factor of mid-term major cardiovascular events (MICE) in the patients. The study is closely related the author’s previous study (Diabetes Care. 2019;42:674-681), but the authors did not properly described it in introduction and discussion.
The reviewer has several comments.
Major comments
- Author’s previous study (Diabetes Care. 2019;42:674-681) examined consecutive patients with diabetes and acute coronary syndrome between January 2015 and November 2016 (same period), and showed GV was an independent predictive factor of mid-term MICE in the patients. Patients with and left ventricular ejection fraction < 40% had a significantly higher incidence of cardiac death, hospitalization for AHF, and MICE. However, the authors described “Nevertheless, the potential effect of glycaemic variability (GV) on mid-term major cardiovascular events (MACE) in diabetic patients remains uncertain.” in abstract. There is a lack of detailed description of the previous in introduction. There is a lack of discussion on GV and AHF in diabetes. The objectivity is not guaranteed. I have a strong concern on the author’s stance on the research.
- Incidence of MICE. The study showed high mortality rate in diabetes with AHF. One-fourth of the patients died of cardiac causes. Please show a figure of survival rate of the all patients and two groups (GV > 50 mg/dL, ≤ 50 mg/dL) and a table of causes of death, and discuss them.
- Are there any difference between patients with GV> 50 mg/dL and GV ≤ 50 mg/dL on clinical and laboratory backgrounds and severity of the underlying cause of AHF.
- Minor comment. Table 1. Glycemic status. Number of glycemia per patient?, Number of glycaemia per patient per day?
Author Response
Please see the attachment.
Author Response File: Author Response.docx
Round 2
Reviewer 3 Report
I have no comment for the revised version.
