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January 28, 2024, 15:13

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This paper on the impact of prediabetes on major adverse cardiac and cerebrovascular events (MACCE) in atrial fibrillation patients offers evidence in support of the harmful impact of prediabetes amongst AF patients. It highlights the heightened endothelial dysfunction and inflammation when the two coexist and lead to additive effects. Though similar impact on MACCE in the presence of prediabetes in AF has been reported before, this document is probably the largest data to date which sheds light on this topic. The paper however could be taken further to discover novel insights and findings in this regard. Here are my suggestions:- 1) Since the authors had the access to database, might as well have analysed the normal patients and diabetic patients also and compared them amongst each other to get Odds ratios of all normal/prediabetes and diabetes. This would have clarified certain questions the readers may have. Further, prediabetes has an annual rate of 5-10% transitioning into diabetes which could have influenced your results. Perhaps that was not taken into account here. Another was would have been to stratify the entire cohort with HBa1C levels. 2) The authors could have analysed the impact of metformin as some of prediabetes patients were likely to be on metformin. This could have answered whether it is the blood glucose control of other variables like inflammation, endothelial dysfunction or the comorbidities that are responsible for the harmful effects amongst prediabets. 3) Definition of prediabetes is necessary. It has not been mentioned here. Whether Hba1c alone or blood glucose samples were taken ? 4) Reason for early discharge after prediabetes has not been discussed. Comes as a surprise to me. 5) Certain typos can be fixed like ("24 sary discharge" in source of data, "On the hand those who revert to normal blood sugar levels experience a decreased risk of heart failure"; other is missing after on the ___ hand) Apart from the limitations accepted by the authors, another drawback is that it only analysis data for hospitalised patients which were discharged subsequently. Since majority of our patients are ambulatory who may not have ever been admitted to the hospital, the findings of this study may not hold true.

First, thank you very much for your professional comments on the article published in World Journal of Diabetes. Second, we read your comments with great interest. You are welcome to format your valuable comments into a Letter to the Editor and submit it online to World Journal of Diabetes at https://www.f6publishing.com. There are no restrictions on the number of words, figures (color, B/W) or authors for a Letter to the Editor. In addition, the article processing charge will be exempted for this Letter to the Editor. As with all articles published by the Baishideng Publishing Group, the Letter to the Editor will be published online after completing peer review. The guidelines for a Letter to the Editor can be found at: https://www.wjgnet.com/bpg/GerInfo/219. Finally, we look forward to receiving your high-quality Letter to the Editor, which will promote academic communication and lead the development of this discipline.