Evaluation of Triglyceride-Glucose Index as a Marker for Severity in New Onset Diabetes in Patients of COVID-19 Pneumonia- a Single Center Study
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IntroductionSevere Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) Covid-19 is responsible for the pandemic affecting the world population since 2019. Starting from Wuhan, China enveloped the globe within a few months. It affected the healthy population, but played havoc in terms of mortality and morbidity for old and diseased populations. Diabetes is a known condition putting patients at high risk of complications, resulting from metabolic syndrome-derived impaired immune responses. The world is still grappling with the challenge of managing diabetic patients with covid pneumonia and newly added Diabetics resulting from post covid complications driven by Covid-19-induced damage to pancreatic beta cells. Resulting in worsening of existing Diabetic control and new onset Diabetes (NOD) in susceptible individuals. The TYG (Triglyceride-Glucose Index) may serve as a marker to identify patients at risk of developing a serious illnessHypothesisTriglyceride Glucose Index is a marker for severity of Covid-19 and new onset of diabetes.Aim To evaluate role of TYG index in prediction of new onset of Diabetes mellitus in Covid-19 patients and as a marker for disease severity in diabetic Covid-19 patients.MethodologyThis cross-sectional study was carried out in Combined Military Hospital (CMH) Rawalakot. Covid-19 patients' diagnosis was confirmed by RT-PCR. Glycosylated hemoglobin (HBA1c), fasting glucose and Triglycerides (TG) were performed at the biochemistry lab using SELECTRA chemical analyzer. TYG index was calculated and related with clinical symptoms of patients.ResultsA total of 2974 samples has been tested by RT-PCR. Three hundred and ninety-three (13%) were positive for COVID-19 infection. Twenty-one patients (5%) developed new-onset Diabetes (NOD) during the COVID infection. A TYG index of 43 people affected with COVID-19 (21 NOD and 22 non-diabetic individuals (control group) was calculated as a marker of severity index. It was found that the higher TYG was associated with severity and mortality in patients with COVID-19 diabetes. ConclusionCovid-19 infection is associated with worsening disease in preexisting diabetic patients and is responsible for new-onset Diabetes in patients. TYG index correlates directly with the severity of Covid-19. TYG index can be used as a predictor marker for mortality and morbidity in Covid-19.
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I am reaching out in regard to your Access Microbiology submission ACMI-D-22-00215R3 titled “Evaluation of Triglyceride-Glucose Index as a Marker for Severity in New Onset Diabetes in Patients of COVID-19 Pneumonia- a Single Center Study.” While the work presented in the submission is scientifically sound, the manuscript has now been through three rounds of revision, during which grammatical corrections were repeatedly requested to improve the clarity of the content. Upon review of the most recent version submitted, the manuscript is still hampered by grammatical errors throughout that make it difficult to read and understand the content. Due to these persistent grammatical issues and the obstacles that they would present for readers, manuscript ACMI-D-22-00215R3 is no longer under consideration for publication in Access Microbiology. I …
I am reaching out in regard to your Access Microbiology submission ACMI-D-22-00215R3 titled “Evaluation of Triglyceride-Glucose Index as a Marker for Severity in New Onset Diabetes in Patients of COVID-19 Pneumonia- a Single Center Study.” While the work presented in the submission is scientifically sound, the manuscript has now been through three rounds of revision, during which grammatical corrections were repeatedly requested to improve the clarity of the content. Upon review of the most recent version submitted, the manuscript is still hampered by grammatical errors throughout that make it difficult to read and understand the content. Due to these persistent grammatical issues and the obstacles that they would present for readers, manuscript ACMI-D-22-00215R3 is no longer under consideration for publication in Access Microbiology. I am sorry that we cannot proceed with publication of your submission at this time and hope that the reviewer and editor feedback received will be helpful in submitting this work for publication elsewhere. Thank you for submitting your manuscript to Access Microbiology and best wishes in your future research endeavours.
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Grammatical errors and issues with complete sentence structure persist in the revised version of the manuscript. There are also typographical errors throughout the submission, such as SARS-CoV-2 written as SARS-CoV2 in some areas and triglyceride-glucose index being indicated as "TG" in the abstract methodology, but "TyG" elsewhere. The manuscript should also be reviewed to ensure correct usage of COVID-19 and SARS-CoV-2 throughout; COVID-19 should be used in instances when referring to the disease (such as patients with diagnosed COVID-19) and SARS-CoV-2 when referring to the virus itself (such as viral detection by RT-PCR). If needed, we offer a discounted translation service, Editage, that you may use to help with these grammatical revisions (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 …
Grammatical errors and issues with complete sentence structure persist in the revised version of the manuscript. There are also typographical errors throughout the submission, such as SARS-CoV-2 written as SARS-CoV2 in some areas and triglyceride-glucose index being indicated as "TG" in the abstract methodology, but "TyG" elsewhere. The manuscript should also be reviewed to ensure correct usage of COVID-19 and SARS-CoV-2 throughout; COVID-19 should be used in instances when referring to the disease (such as patients with diagnosed COVID-19) and SARS-CoV-2 when referring to the virus itself (such as viral detection by RT-PCR). If needed, we offer a discounted translation service, Editage, that you may use to help with these grammatical revisions (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information). The authors also state in the submission that all patients gave informed consent but no signed forms showing this were submitted with the manuscript. Please include these forms.
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The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments. Having received reviewer comments, it is clear the work requires additional experimental work.
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Comments to Author
The is a small opportunistic study of patients with confirmned COVID-19 presenting with New Onset Diabetes compared to non-diabetic controls; patients with diabetes were excluded. The biochemistry markers and the Triglyceride-Glucose Index were measured to indicate disease severity. Methodological rigour, reproducibility and availability of underlying data The reference to SARS-CoV is not relevant. Description of the shape of the virus in a historical context is not relevant L102 - needs a reference The methodology for describing COVID RTPCR is unnecessarily detailed - referencing stabdard methods would be sufficient. The study groups are small and likely to be unrepresentative of larger study populations. Diabetics were exclused but NOD were enrolled. How were NOD differentiated from long standing …
Comments to Author
The is a small opportunistic study of patients with confirmned COVID-19 presenting with New Onset Diabetes compared to non-diabetic controls; patients with diabetes were excluded. The biochemistry markers and the Triglyceride-Glucose Index were measured to indicate disease severity. Methodological rigour, reproducibility and availability of underlying data The reference to SARS-CoV is not relevant. Description of the shape of the virus in a historical context is not relevant L102 - needs a reference The methodology for describing COVID RTPCR is unnecessarily detailed - referencing stabdard methods would be sufficient. The study groups are small and likely to be unrepresentative of larger study populations. Diabetics were exclused but NOD were enrolled. How were NOD differentiated from long standing diabetics. No details of the patients in relation to the stage of the acute COVID-19 infection are given e.g. days into illness, Ct values of the RT-PCR. 95% of the NOD patients received steroids compared to 18% in the control group which could explain some of the findings. Compaing NOD patients to non diabetic COVID-19 positive patients will inevitably demonstrate the clinical chemistry differences shown in the study. Presentation of results The study presents 2 study groups - NOD and non diabetic. For severity an additional table was for patients who died - which came from the NOD group and those who survived. It is unclear which groups are being used for demonstrating prediction of disease severity How the style and organization of the paper communicates and represents key findings The findings of this study might be better argued in a clinical chemistry journal rather than a microbiology journal as the implied link of the pathophysiology of COVID-19 to diabetes and the TyG Index is not that clear from a microbiology perspective.
Please rate the manuscript for methodological rigour
Poor
Please rate the quality of the presentation and structure of the manuscript
Poor
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
1. Authors should specify which area in line number 82 and 83. 2. Line 137 - Who were the controls used in the study? Authors should have used non-diabetic covid-19 negative patients in the study for correlation and for validation. 3. Line 141 - How long the sample was stored? Was the sample stable ? What type of viral transport medium was used? Which company's? Line 148 - Was the RNA obtained checked for purity?
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
Comments to Author
1. Authors should specify which area in line number 82 and 83. 2. Line 137 - Who were the controls used in the study? Authors should have used non-diabetic covid-19 negative patients in the study for correlation and for validation. 3. Line 141 - How long the sample was stored? Was the sample stable ? What type of viral transport medium was used? Which company's? Line 148 - Was the RNA obtained checked for purity?
Please rate the manuscript for methodological rigour
Satisfactory
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Partially support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The language used is poor, which can cause ambiguity at times. Please carefully rewrite it. We offer a discounted translation service, Editage (https://www.editage.com/; see https://www.microbiologyresearch.org/prepare-an-article#13 for more information). For revision please focus on the following areas. Grammatical corrections are needed throughout the paper. Addition of references is required, as similarity scores to other publications were notably high. If quoting other publications directly, please include quotations around quoted phrases and sentences. Finally, please address the lack of patients with pre-existing diabetes used for control comparison in the study.
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