Challenges in Diabetic Micro-Complication Management: Focus on Diabetic Neuropathy

Round 1

Reviewer 1 Report

This review discusses the current literature regarding diabetes-associated neuropathy. Significant changes to the manuscript are needed.

-When referencing epidemiological studies, inclusion of the sample size is really needed to understand the generalizability of the referenced study. Some of the conflicting data regarding T1DM and T2DM is likely attributed to study design, i.e., was Hb1Ac measured in these studies, timeframe of DM prior to diagnosis of neuropathy, average age of patients, etc. A more critical and thoughtful review of the literature is needed.

-No mention of the detrimental effects of neuropathy, other than chronic pain, is included. The essential contribution of nerves in different tissues, such as the cornea and skin, should be discussed.

-The role of systemic inflammation in DM and effects on nerve fibers should be mentioned. Specific mediators involved in nerve loss / damage should likewise be included in a review of the neuropathy. 

-Please correct grammatical issues throughout. 

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

The authors presented an interesting review on diabetic neuropathy. The manuscript is with merit and the findings are worth reporting. However, before publication could be considered, the authors should revise the manuscript and address the following concerns.

• Introduction: add a brief introduction about diabetes in general at the very beginning of the manuscript
• Material and Methods: this section is missing from the manuscript. The authors should add this section as section “2” of the manuscript, providing information related to their literature serach: which data bases were used, which keywords, time range etc
• The authors should revise and improve the language and syntax of the entire manuscript, for example at line 28-29 “The most prevalent and frequently observed subtype of this peripheral 28 neuropathy is diabetic neuropathy. Which is defined as “pain as a direct consequence of 29 abnormalities in the peripheral somatosensory system in patient with diabetes” [1].” Should be “The most prevalent and frequently observed subtype of this peripheral neuropathy is diabetic neuropathy, which is defined as “pain as a direct consequence of 29 abnormalities in the peripheral somatosensory system in patient with diabetes” [1].”

Author Response

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Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

The revision addressed most of my concerns.

Author Response

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Author Response File: Author Response.pdf

Reviewer 2 Report

The authors addressed the comments, but they should provide additional information regarding the literature search. 

In details, they should provide the complete list of keywords used in details, and edit correspondingly the "methods" sections by revising the sentence "using several keywords such as...".

In addition, the authors should indicate precisely when the research was conducted and indicate it in the "methods" with a sentence such as "PubMed and Google scholar searches were conducted from all available published articles through ..". 

Finally, revise the sentence "We limited our search to the last ten years or, in some cases, five years, but we did not adhere time constraints on epidemiological data" and provide more detailed information. 

Author Response

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Author Response File: Author Response.pdf