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Thank you for carefully attending to the suggestions of the reviewers. I am happy to recommend that the journal accept the study now - many congratulations.
[# PeerJ Staff Note - this decision was reviewed and approved by Stefano Menini, a PeerJ Section Editor covering this Section #]
Both reviewers concur that this study is interesting and has merit. Please attend to the minor comments enclosed (note reviewer-1 has sent a PDF with comments). These are largely stylistic issues and requests for clarification or further information.
Address all comments fully in your revision, please.
[# PeerJ Staff Note: It is PeerJ policy that additional references suggested during the peer-review process should only be included if the authors are in agreement that they are relevant and useful #]
Please check the PDF for my comments
Please check the PDF for my comments
Please check the PDF for my comments
Please check the PDF for my comments
The manuscript “Quality of care and prescription patterns among patients with diabetic kidney disease - A large-scale cohort study from Taiwanese clinics” investigates the quality of care and prescription patterns, obtained from retrospective chart review of patients with diabetic kidney disease (DKD) receiving primary care at 43 primary care clinics in Taiwan.
I have minor suggestions to the manuscript.
- English style needs to be improved
Discussion should: be more focused on the results.
Discussion section: These paragraphs reporting the results of the main CVOTs on SGLT2i and GLP1RAs should be removed/shortened : “ In the DAPA-CKD trial, (including CKD patients with an eGFR of as low as 25 ml/min/1.73m2 252 and a urinary albumin-to-creatinine ratio of 200 to 5000mg/g creatinine), SGLT-2 inhibitor 253 showed lower risks of renal complications; decline of eGFR, progression to ESRD, and death 254 from renal or cardiovascular causes.(Heerspink et al., 2020) Also, in the CANVAS-R trial, the 255 SGLT-2 inhibitor also demonstrated the capability to slow progression of albuminuria and to 256 reduce renal events in the patients with type 2 diabetes mellitus and high cardiovascular 257 risk.(Neal et al., 2017) In our study, although diabetes patients with DKD were more likely to be 258 prescribed SGLT-2 inhibitors, the proportion of SGLT-2 inhibitors was still less than DPP-4 259 inhibitors and sulfonylurea in monotherapy and dual therapy. It might be possible that SGLT-2 260 inhibitors were only prescribed to patients with eGFR > 45ml/min/1.73m2 when the study was 261 conducted in 2019. However, since then, growing evidence suggests SGLT-2 inhibitors provide 262 cardiovascular and renal benefits in patients with advanced CKD. Today, some SGLT-2 263 inhibitors are prescribed to eGFR ≥30ml/min/1.73m2 patients as well. As application criteria 264 changes, SGLT-2 inhibitors may be more applicable and acceptable to more DKD patients.” and “GLP-1 RAs were also recommended to CKD patients for their ability to reduce risks of 267 cardiovascular events, hypoglycemia and possibly slowing CKD progression.(Marso et al., 268 2016a; Marso et al., 2016b) In an exploratory analysis of the REWIND trial, dulaglutide showed 269 a 15% reduction in incidence of composite renal outcome and attenuation of eGFR 270 decline.(Gerstein et al., 2019) The prespecified secondary analysis of the LEADER trial revealed 271 that liraglutide had a lower rate of DKD development and progression.(Mann et al., 2017) 272 However, in our study, prescription of GLP-1 RA did not show significant difference between 273 DKD and non-DKD patients (adjusted OR 1.24; 95% CI [0.95 - 1.61], p = 0.104) and the overall 274 prescription rate was low. The difference may be due to strict reimbursement criteria and 275 patients’ preference for oral medications”.
You may use a review instead, see : Greco EV, et al. GLP-1 Receptor Agonists and Kidney Protection. Medicina (Kaunas). 2019 May31;55(6):233. doi: 10.3390/medicina55060233. PMID: 31159279; PMCID: PMC6630923. and Bailey, C.J., et al. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep 22, 39–52 (2022). https://doi.org/10.1007/s11892-021-01442-z
Discussion section: A comment to compare the contemporary use of SGLT2i/GLP1RAs in Taiwan vs that in T2DM from primary and secondary care all over the world should also be included. At this regard, please see Mosenzon, O. et al, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol 20, 154 (2021). https://doi.org/10.1186/s12933-021-01344-0.
Discussion section: Also a brief comment on therapeutic inertia and the potential risks associated with the use of SU in old patients with impaired renal function should also be added.
Results/Discussion section: An analysis/comment on potential differences in the results based on age and gender could improve the manuscript: at this regard, you may see: Giandalia A. et al. Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors. Int J Mol Sci. 2021 May 28;22(11):5808. doi:10.3390/ijms22115808. PMID: 34071671; PMCID: PMC8198374.
The manuscript “Quality of care and prescription patterns among patients with diabetic kidney disease - A large-scale cohort study from Taiwanese clinics” investigates the quality of care and prescription patterns, obtained from retrospective chart review of patients with diabetic kidney disease (DKD) receiving primary care at 43 primary care clinics in Taiwan.
I have minor suggestions to the manuscript.
- English style needs to be improved
Discussion should: be more focused on the results.
Discussion section: These paragraphs reporting the results of the main CVOTs on SGLT2i and GLP1RAs should be removed/shortened : “ In the DAPA-CKD trial, (including CKD patients with an eGFR of as low as 25 ml/min/1.73m2 252 and a urinary albumin-to-creatinine ratio of 200 to 5000mg/g creatinine), SGLT-2 inhibitor 253 showed lower risks of renal complications; decline of eGFR, progression to ESRD, and death 254 from renal or cardiovascular causes.(Heerspink et al., 2020) Also, in the CANVAS-R trial, the 255 SGLT-2 inhibitor also demonstrated the capability to slow progression of albuminuria and to 256 reduce renal events in the patients with type 2 diabetes mellitus and high cardiovascular 257 risk.(Neal et al., 2017) In our study, although diabetes patients with DKD were more likely to be 258 prescribed SGLT-2 inhibitors, the proportion of SGLT-2 inhibitors was still less than DPP-4 259 inhibitors and sulfonylurea in monotherapy and dual therapy. It might be possible that SGLT-2 260 inhibitors were only prescribed to patients with eGFR > 45ml/min/1.73m2 when the study was 261 conducted in 2019. However, since then, growing evidence suggests SGLT-2 inhibitors provide 262 cardiovascular and renal benefits in patients with advanced CKD. Today, some SGLT-2 263 inhibitors are prescribed to eGFR ≥30ml/min/1.73m2 patients as well. As application criteria 264 changes, SGLT-2 inhibitors may be more applicable and acceptable to more DKD patients.” and “GLP-1 RAs were also recommended to CKD patients for their ability to reduce risks of 267 cardiovascular events, hypoglycemia and possibly slowing CKD progression.(Marso et al., 268 2016a; Marso et al., 2016b) In an exploratory analysis of the REWIND trial, dulaglutide showed 269 a 15% reduction in incidence of composite renal outcome and attenuation of eGFR 270 decline.(Gerstein et al., 2019) The prespecified secondary analysis of the LEADER trial revealed 271 that liraglutide had a lower rate of DKD development and progression.(Mann et al., 2017) 272 However, in our study, prescription of GLP-1 RA did not show significant difference between 273 DKD and non-DKD patients (adjusted OR 1.24; 95% CI [0.95 - 1.61], p = 0.104) and the overall 274 prescription rate was low. The difference may be due to strict reimbursement criteria and 275 patients’ preference for oral medications”.
You may use a review instead, see : Greco EV, et al. GLP-1 Receptor Agonists and Kidney Protection. Medicina (Kaunas). 2019 May31;55(6):233. doi: 10.3390/medicina55060233. PMID: 31159279; PMCID: PMC6630923. and Bailey, C.J., et al. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep 22, 39–52 (2022). https://doi.org/10.1007/s11892-021-01442-z
Discussion section: A comment to compare the contemporary use of SGLT2i/GLP1RAs in Taiwan vs that in T2DM from primary and secondary care all over the world should also be included. At this regard, please see Mosenzon, O. et al, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol 20, 154 (2021). https://doi.org/10.1186/s12933-021-01344-0.
Discussion section: Also a brief comment on therapeutic inertia and the potential risks associated with the use of SU in old patients with impaired renal function should also be added.
Results/Discussion section: An analysis/comment on potential differences in the results based on age and gender could improve the manuscript: at this regard, you may see: Giandalia A. et al. Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors. Int J Mol Sci. 2021 May 28;22(11):5808. doi:10.3390/ijms22115808. PMID: 34071671; PMCID: PMC8198374.
The manuscript “Quality of care and prescription patterns among patients with diabetic kidney disease - A large-scale cohort study from Taiwanese clinics” investigates the quality of care and prescription patterns, obtained from retrospective chart review of patients with diabetic kidney disease (DKD) receiving primary care at 43 primary care clinics in Taiwan.
I have minor suggestions to the manuscript.
- English style needs to be improved
Discussion should: be more focused on the results.
Discussion section: These paragraphs reporting the results of the main CVOTs on SGLT2i and GLP1RAs should be removed/shortened : “ In the DAPA-CKD trial, (including CKD patients with an eGFR of as low as 25 ml/min/1.73m2 252 and a urinary albumin-to-creatinine ratio of 200 to 5000mg/g creatinine), SGLT-2 inhibitor 253 showed lower risks of renal complications; decline of eGFR, progression to ESRD, and death 254 from renal or cardiovascular causes.(Heerspink et al., 2020) Also, in the CANVAS-R trial, the 255 SGLT-2 inhibitor also demonstrated the capability to slow progression of albuminuria and to 256 reduce renal events in the patients with type 2 diabetes mellitus and high cardiovascular 257 risk.(Neal et al., 2017) In our study, although diabetes patients with DKD were more likely to be 258 prescribed SGLT-2 inhibitors, the proportion of SGLT-2 inhibitors was still less than DPP-4 259 inhibitors and sulfonylurea in monotherapy and dual therapy. It might be possible that SGLT-2 260 inhibitors were only prescribed to patients with eGFR > 45ml/min/1.73m2 when the study was 261 conducted in 2019. However, since then, growing evidence suggests SGLT-2 inhibitors provide 262 cardiovascular and renal benefits in patients with advanced CKD. Today, some SGLT-2 263 inhibitors are prescribed to eGFR ≥30ml/min/1.73m2 patients as well. As application criteria 264 changes, SGLT-2 inhibitors may be more applicable and acceptable to more DKD patients.” and “GLP-1 RAs were also recommended to CKD patients for their ability to reduce risks of 267 cardiovascular events, hypoglycemia and possibly slowing CKD progression.(Marso et al., 268 2016a; Marso et al., 2016b) In an exploratory analysis of the REWIND trial, dulaglutide showed 269 a 15% reduction in incidence of composite renal outcome and attenuation of eGFR 270 decline.(Gerstein et al., 2019) The prespecified secondary analysis of the LEADER trial revealed 271 that liraglutide had a lower rate of DKD development and progression.(Mann et al., 2017) 272 However, in our study, prescription of GLP-1 RA did not show significant difference between 273 DKD and non-DKD patients (adjusted OR 1.24; 95% CI [0.95 - 1.61], p = 0.104) and the overall 274 prescription rate was low. The difference may be due to strict reimbursement criteria and 275 patients’ preference for oral medications”.
You may use a review instead, see : Greco EV, et al. GLP-1 Receptor Agonists and Kidney Protection. Medicina (Kaunas). 2019 May31;55(6):233. doi: 10.3390/medicina55060233. PMID: 31159279; PMCID: PMC6630923. and Bailey, C.J., et al. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep 22, 39–52 (2022). https://doi.org/10.1007/s11892-021-01442-z
Discussion section: A comment to compare the contemporary use of SGLT2i/GLP1RAs in Taiwan vs that in T2DM from primary and secondary care all over the world should also be included. At this regard, please see Mosenzon, O. et al, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol 20, 154 (2021). https://doi.org/10.1186/s12933-021-01344-0.
Discussion section: Also a brief comment on therapeutic inertia and the potential risks associated with the use of SU in old patients with impaired renal function should also be added.
Results/Discussion section: An analysis/comment on potential differences in the results based on age and gender could improve the manuscript: at this regard, you may see: Giandalia A. et al. Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors. Int J Mol Sci. 2021 May 28;22(11):5808. doi:10.3390/ijms22115808. PMID: 34071671; PMCID: PMC8198374.
The manuscript “Quality of care and prescription patterns among patients with diabetic kidney disease - A large-scale cohort study from Taiwanese clinics” investigates the quality of care and prescription patterns, obtained from retrospective chart review of patients with diabetic kidney disease (DKD) receiving primary care at 43 primary care clinics in Taiwan.
I have minor suggestions to the manuscript.
- English style needs to be improved
Discussion should: be more focused on the results.
Discussion section: These paragraphs reporting the results of the main CVOTs on SGLT2i and GLP1RAs should be removed/shortened : “ In the DAPA-CKD trial, (including CKD patients with an eGFR of as low as 25 ml/min/1.73m2 252 and a urinary albumin-to-creatinine ratio of 200 to 5000mg/g creatinine), SGLT-2 inhibitor 253 showed lower risks of renal complications; decline of eGFR, progression to ESRD, and death 254 from renal or cardiovascular causes.(Heerspink et al., 2020) Also, in the CANVAS-R trial, the 255 SGLT-2 inhibitor also demonstrated the capability to slow progression of albuminuria and to 256 reduce renal events in the patients with type 2 diabetes mellitus and high cardiovascular 257 risk.(Neal et al., 2017) In our study, although diabetes patients with DKD were more likely to be 258 prescribed SGLT-2 inhibitors, the proportion of SGLT-2 inhibitors was still less than DPP-4 259 inhibitors and sulfonylurea in monotherapy and dual therapy. It might be possible that SGLT-2 260 inhibitors were only prescribed to patients with eGFR > 45ml/min/1.73m2 when the study was 261 conducted in 2019. However, since then, growing evidence suggests SGLT-2 inhibitors provide 262 cardiovascular and renal benefits in patients with advanced CKD. Today, some SGLT-2 263 inhibitors are prescribed to eGFR ≥30ml/min/1.73m2 patients as well. As application criteria 264 changes, SGLT-2 inhibitors may be more applicable and acceptable to more DKD patients.” and “GLP-1 RAs were also recommended to CKD patients for their ability to reduce risks of 267 cardiovascular events, hypoglycemia and possibly slowing CKD progression.(Marso et al., 268 2016a; Marso et al., 2016b) In an exploratory analysis of the REWIND trial, dulaglutide showed 269 a 15% reduction in incidence of composite renal outcome and attenuation of eGFR 270 decline.(Gerstein et al., 2019) The prespecified secondary analysis of the LEADER trial revealed 271 that liraglutide had a lower rate of DKD development and progression.(Mann et al., 2017) 272 However, in our study, prescription of GLP-1 RA did not show significant difference between 273 DKD and non-DKD patients (adjusted OR 1.24; 95% CI [0.95 - 1.61], p = 0.104) and the overall 274 prescription rate was low. The difference may be due to strict reimbursement criteria and 275 patients’ preference for oral medications”.
You may use a review instead, see : Greco EV, et al. GLP-1 Receptor Agonists and Kidney Protection. Medicina (Kaunas). 2019 May31;55(6):233. doi: 10.3390/medicina55060233. PMID: 31159279; PMCID: PMC6630923. and Bailey, C.J., et al. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep 22, 39–52 (2022). https://doi.org/10.1007/s11892-021-01442-z
Discussion section: A comment to compare the contemporary use of SGLT2i/GLP1RAs in Taiwan vs that in T2DM from primary and secondary care all over the world should also be included. At this regard, please see Mosenzon, O. et al, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol 20, 154 (2021). https://doi.org/10.1186/s12933-021-01344-0.
Discussion section: Also a brief comment on therapeutic inertia and the potential risks associated with the use of SU in old patients with impaired renal function should also be added.
Results/Discussion section: An analysis/comment on potential differences in the results based on age and gender could improve the manuscript: at this regard, you may see: Giandalia A. et al. Gender Differences in Diabetic Kidney Disease: Focus on Hormonal, Genetic and Clinical Factors. Int J Mol Sci. 2021 May 28;22(11):5808. doi:10.3390/ijms22115808. PMID: 34071671; PMCID: PMC8198374.
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