Gal Tsaban et al. evaluated the effects of Mankai on postprandial glucose (PG) excursions in type 2 diabetes (T2D)

They concluded that Mankai consumption may mitigate the PG response in people with T2D with ~20% improvement in glycemic parameters. These findings provide case-study evidence for plant-based treatments in T2D to complement a healthy lifestyle and pharmacotherapy.

Several issues should be addressed before the paper is suitable for publication. Though the topic is relevant, some flaws need to be acknowledged:

1. Line 256 (300 ml) does not correspond with line 76 (200 ml).

2. How it was calculated a sample size for each group? Was it enough to compare the two groups for statistical power?

3. The name of the paper is “The effect of Mankai plant consumption … among patients with T2D”, but FPG did not significantly change in Mankai intervention, and HbA1c was not presented due to very short treatment duration. The name of the paper does not correspond with the results.

4. The authors should present 24-hour glucose outcomes in both group not only 5-hour postprandial outcomes, given that FPG did not significantly change in Mankai group.

5. The positive postprandial effect of Mankai might have due to absorption effect of glucose and triglycerides in the gut, as it is rich in fiber and polyphenols containing bioavailable protein.

6. Table 1: the table has to show P-value between the two groups at baseline, especially in WC, TG, AST, ALT, taking medications of GLP-1a, TSD, Insulin.

7. In my opinion, patients taking insulin should not be included in the study, especially since their number was only 8% of the total number of participants.

8. Fig. 3: the results of reduction in the TG/HDL-c ratio in the Mankai group vs. water may not be as important from a scientific point of view, since TG/HDL-c level was significantly higher in the Mankai group at baseline.

9. Among All figures: if the authors used one color for one comparison group, please use the same color for the group in all the figures for a better and faster understanding of the results.

10. “…only 2/3 of the individuals beneficially responded to Mankai”, could it be related with diet, physical activity, or else?

11. Weight (weight change) was not included for measurement in both compared groups, why?

12. The trial had a crossover design, but the results of the crossover study were not presented.

Only one comment: “we found a trend towards improvement, but there was no significant effect” - this is not yet a scientific reason to use the substance.