Content of review 1, reviewed on November 16, 2025

General comments:

  1. Meçani et al describe glucose outcomes during plane-travel in 20 people with type 1 diabetes treated with automatic insulin delivery systems.
    The subject is relevant and the results, reassuring, but more detail is needed to understand the design of the study.

Specific comments:

  1. Methods: The authors state that no randomisation was performed. How was the on-ground control period chosen?

  2. A fed and a non-fed state were included. What did the standardised meal
    mentioned in the methods section consist of?

  3. More detail is needed about the on-flight and on-ground situations, as well as on the statistical analyses.

  4. Results: What were the average HbA1c concentrations of the included subjects?

  5. Data is duplicated in text and tables. Please, remove duplicate information from the text and remove table 2, which shows the same information as table 1. For table 1, please show results of statistical analysis.

  6. Cabin pressure is reported to have been measured, but no results are given.

Source

    © 2025 the Reviewer.

Content of review 2, reviewed on December 06, 2025

The authors provide a revised version of the manuscript, which includes some more details about the methods. However, more information is needed to complete this section. Indeed, the response letter includes more details than the manuscript itself.

For example, patients come from two different centres, but only the ethics approval of the centre in Austria is mentioned, and there is no evidence of additional involvement of the German centre in the study. Furthermore, where were the on-ground assesments performed? Information should include the dates, the reason for choosing specific dates, the reason for choosing the given flights and the time of the day and conditions in which the participants came to the centre for on-ground evaluation. The same is applicable to the in-flight periods. Was the same standarised meal ingested during the flight? This could be made clearer in the text

The exploratory nature of the study does not preclude statistical analyses, and could be done now if not previously performed.

Please, move results from the methods section to the results section (e.g cabin pressure, which can be described in more detail, if continuously monitored by a researcher).

Please, check the funding information. There are contradictions between the paper and the registered protocol.

Source

    © 2025 the Reviewer.

Content of review 3, reviewed on December 13, 2025

Thank you for the additional analyses. Please, include the description in the methods section, including the rationale for the choice of flight.

Source

    © 2025 the Reviewer.

References

    Renald, M., Silvia, B., M., B. P., Monika, C., Omaima, E. H., A., H. D., Fariba, S., Siu, F. K., Dietrich, T., R., P. T., David, R., Chantal, M., Gerd, K., K., M. J. In-Flight Glycemic Control Using Automated Insulin Delivery Systems: A Within-Subject Comparative Pilot Study. Diabetes, Obesity and Metabolism.