Multimorbidity from Diabetes, Heart Failure, and Related Conditions: Assessing a Panel of Depressive Symptoms as Both Formative and Reflective Indicators of a Latent Trait

Round 1

Reviewer 1 Report

Esteemed Author,

It has been a great honor, as well as a pleasantly challenging activity, to review the article entitled ”Multimorbidity from diabetes, heart failure, and related conditions: Assessing a panel of depressive symptoms as both formative and reflective indicators of a latent trait.”

Diabetes is one of the major diseases, a disease with significant medical, economic and social consequences. Diabetes is a disease characterized by abnormal blood sugar levels and represents a growing threat to human health. Over 33 million people in the European Union (EU) have diabetes. According to IDF (International Diabetes Federation) data, the absolute number of diabetics in the EU will rise from approximately 33 million in 2010 to 38 million in 2030. Except for genetic conditions or particular types of diabetes (like type-1 diabetes), it is often a preventable chronic disease through a healthy lifestyle starting in childhood.

Worldwide the situation is almost dramatic. Diabetes mellitus and its complications are significant global public health problems. In 2017, there were 427 million adults estimated with diabetes worldwide, of which 58 million people in the European Region. It is expected that the number was increasing to almost 629 million people in 2045. Noteworthy, one in two adults with diabetes is undiagnosed.

Overweight/obesity, unhealthy habits, inappropriate physical activity, and an aging global population are the significant risk factors for diabetes. Therefore, prevention and early and appropriate interventions are necessary measures to reduce the prevalence and complications of diabetes.

From this point of view, the article approaches a highly significant topic to people and public health systems and their evolution to ensure improvement, especially regarding the interaction between these systems and public policies in the considered area.

The paper is of significant value due to its original character; it treats a specific subject of high interest in medicine, therapy, public policies, sustainable development of pension systems, and public health. With some minor exceptions (which refers to some descriptions necessary), all materials and methods are specified and described adequately. Even though the study does display certain limitations, the approach to the topic itself is a solid one, well-argued and unequivocal.

With some minor exceptions, the paper is well structured and possesses an appreciable novelty character. The major components of the article – Introduction, Materials and Methods, Results, and Discussion - are organized judiciously and in direct connection with one another. Concerning this aspect, I have only one minor suggestion: I believe that in relationship with the organization of the paper, the introduction of a short final chapter reserved for conclusions would give greater solidity to the general structure of the article.

As there are many recurring terms in the article, a list of abbreviations at the end of the report would be welcome (a situation that simplifies the text and makes it easier to navigate and understand).

The documentation is adequate, and all the authors are cited in the text of the paper. The author of the article need to pay more attention to writing (editing of text): the existence of some small writing errors (errors of editing) makes it harder to check the citations (checking the authors from the bibliographic reference list), and it can create some confusion in terms of understanding specialized terms.

Besides, considering the provisions of international copyright and intellectual property law, it is recommended that all authors of an article be listed in the bibliography (even if their number is sometimes high or very high).

I would also recommend that greater attention be paid when it comes to chapters from books. The number of pages, the publishing houses, and other identification elements (link, Digital Object Identifier – DOI, etc.) be mentioned, regardless of the reference type.

The authors' mentioning in the list of references in alphabetical order, from A to Z, is also recommended: thus, the text becomes way more readable, and the cited authors are more visible and easy to find and verified. This is important because, generally, there may be authors with works from different years.

The provided scientific results are exact and precise. The goal of the conducted research is well specified and delineated. The working protocol is appropriate, and the used analysis methods are coherent with the proposed objectives.

The obtained results are interpreted correctly. Their practical value is visible: however, some data are not clearly expressed in the text, which needs to be remedied by the author.

The graphical representation of the results is adequate: both tables and figures have appropriate titles for the presented data. The submitted data are factually correct, with a logical and coherent connection between the text's data and those in figures and tables.

As for the grammar of the paper, most of the text is very well written, with few parts that would require some modifications – just a few minor recommendations, as follows:

Page 12, line 555 – replace “incorporates all relevant” with “incorporates all the relevant”;

Page 12, line 578 – replace “multicolinearity” with “multicollinearity”;

Page 17, line 833 – replace “regression” with “regressions”.

The article itself, like any other article, has certain improvable aspects. By these aspects, I mean the significant parts of the paper and some elements related to details or writing. Minor corrections and clarifications notwithstanding, the author’s work and obtained results are highly commendable. They bring significant added value to the work and may constitute a launching pad for further valuable studies.

Provided that the author verify the paper and perform the required corrections, the article can be accepted and published in Mathematics.

Best Regards,

Reviewer

Author Response

Please see the attachment.

Author Response File: Author Response.doc