Content of review 1, reviewed on March 06, 2025
An interesting study utilising ITD rats as a model for studying the effect of recurrent hypoglycaemia (RH) exposure on platelet function and thrombosis. The authors go on to relate their findings to the human situation where hypoglycaemia is well described in association with increased risk of cardiovascular events by unknown mechanisms.
The work has novelty and reports potentially important data relevant to the human situation.
I suggest a couple of points for inclusion in their manuscript:
- They discuss diabetes as if it was a single disease-they should emphasise that their findings only relate to an INSULIN treated animal model. In the human situation, many patients report hypoglycaemia on oral therapy which includes sulphonylureas and glinides. Their study does not include these therapies and they need to caution beyond therapies not including insulin. Please emphasise this point in the manuscript.
2.They go to some length to suggest that DPP-4 inhibitors are associated with reduced risk of hypoglycaemia and CV events but fail to mention similar observations with GLP-1RAs and SGLT-2 inhibitors. Please amend.
- The authors emphasise in their final sentence that further studies are required to delineate the importance of changes in platelet function and thrombosis in explaining the increased risk of CV events in association with hypoglycaemia in the insulin treated state. These studies are required both in animal models and humans. Could the authors be more specific and perhaps add a few sentences on what studies they would recommend both in animal models and humans?
Source
© 2025 the Reviewer.
Content of review 2, reviewed on April 24, 2025
The authors have answered the various points made by referees and their paper has benefited as a result.
I would like to congratulate the authors on sharing their interesting, highly relevant and potentially important research.
Source
© 2025 the Reviewer.
References
K., R. A., Sunjoo, C., Allen, L., Jonathan, L., S., K. S., Nathalie, K., A., P. M., Wenche, J., R., D. K. 2025. Recurrent hypoglycemia exposure increases the risk of platelet activation and thrombosis in insulin-treated diabetic rats. Diabetes, Obesity and Metabolism.
