Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study

Knowledge, attitudes, and practices of Lebanese... | F1000Research "use strict";function _typeof(t){return(_typeof="function"==typeof Symbol&&"symbol"==typeof Symbol.iterator?function(t){return typeof t}:function(t){return t&&"function"==typeof Symbol&&t.constructor===Symbol&&t!==Symbol.prototype?"symbol":typeof t})(t)}!function(){var t=function(){var t,e,o=[],n=window,r=n;for(;r;){try{if(r.frames.__tcfapiLocator){t=r;break}}catch(t){}if(r===n.top)break;r=r.parent}t||(!function t(){var e=n.document,o=!!n.frames.__tcfapiLocator;if(!o)if(e.body){var r=e.createElement("iframe");r.style.cssText="display:none",r.name="__tcfapiLocator",e.body.appendChild(r)}else setTimeout(t,5);return!o}(),n.__tcfapi=function(){for(var t=arguments.length,n=new Array(t),r=0;r 3&&2===parseInt(n[1],10)&&"boolean"==typeof n[3]&&(e=n[3],"function"==typeof n[2]&&n[2]("set",!0)):"ping"===n[0]?"function"==typeof n[2]&&n[2]({gdprApplies:e,cmpLoaded:!1,cmpStatus:"stub"}):o.push(n)},n.addEventListener("message",(function(t){var e="string"==typeof t.data,o={};if(e)try{o=JSON.parse(t.data)}catch(t){}else o=t.data;var n="object"===_typeof(o)&&null!==o?o.__tcfapiCall:null;n&&window.__tcfapi(n.command,n.version,(function(o,r){var a={__tcfapiReturn:{returnValue:o,success:r,callId:n.callId}};t&&t.source&&t.source.postMessage&&t.source.postMessage(e?JSON.stringify(a):a,"*")}),n.parameter)}),!1))};"undefined"!=typeof module?module.exports=t:t()}(); dataLayer = dataLayer || []; // Standard GTM initialization - Google Consent Mode handles consent automatically (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl+ '>m_auth=hzk0Vc3qFsQYhCrIoHz68A>m_preview=env-1>m_cookies_win=x';f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-MWFK8L5J'); ;window.NREUM||(NREUM={});NREUM.init={distributed_tracing:{enabled:true},privacy:{cookies_enabled:true},ajax:{deny_list:["bam.nr-data.net"]}}; ;NREUM.loader_config={accountID:"438030",trustKey:"438030",agentID:"772317073",licenseKey:"97f8f67f26",applicationID:"772317073"} ;NREUM.info={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net",licenseKey:"97f8f67f26",applicationID:"772317073",sa:1} ;/*! For license information please see nr-loader-spa-1.236.0.min.js.LICENSE.txt */ (()=>{"use strict";var e,t,r={5763:(e,t,r)=>{r.d(t,{P_:()=>l,Mt:()=>g,C5:()=>s,DL:()=>v,OP:()=>T,lF:()=>D,Yu:()=>y,Dg:()=>h,CX:()=>c,GE:()=>b,sU:()=>_});var n=r(8632),i=r(9567);const o={beacon:n.ce.beacon,errorBeacon:n.ce.errorBeacon,licenseKey:void 0,applicationID:void 0,sa:void 0,queueTime:void 0,applicationTime:void 0,ttGuid:void 0,user:void 0,account:void 0,product:void 0,extra:void 0,jsAttributes:{},userAttributes:void 0,atts:void 0,transactionName:void 0,tNamePlain:void 0},a={};function s(e){if(!e)throw new Error("All info objects require an agent identifier!");if(!a[e])throw new Error("Info for ".concat(e," was never set"));return a[e]}function c(e,t){if(!e)throw new Error("All info objects require an agent identifier!");a[e]=(0,i.D)(t,o),(0,n.Qy)(e,a[e],"info")}var u=r(7056);const d=()=>{const e={blockSelector:"[data-nr-block]",maskInputOptions:{password:!0}};return{allow_bfcache:!0,privacy:{cookies_enabled:!0},ajax:{deny_list:void 0,enabled:!0,harvestTimeSeconds:10},distributed_tracing:{enabled:void 0,exclude_newrelic_header:void 0,cors_use_newrelic_header:void 0,cors_use_tracecontext_headers:void 0,allowed_origins:void 0},session:{domain:void 0,expiresMs:u.oD,inactiveMs:u.Hb},ssl:void 0,obfuscate:void 0,jserrors:{enabled:!0,harvestTimeSeconds:10},metrics:{enabled:!0},page_action:{enabled:!0,harvestTimeSeconds:30},page_view_event:{enabled:!0},page_view_timing:{enabled:!0,harvestTimeSeconds:30,long_task:!1},session_trace:{enabled:!0,harvestTimeSeconds:10},harvest:{tooManyRequestsDelay:60},session_replay:{enabled:!1,harvestTimeSeconds:60,sampleRate:.1,errorSampleRate:.1,maskTextSelector:"*",maskAllInputs:!0,get blockClass(){return"nr-block"},get ignoreClass(){return"nr-ignore"},get maskTextClass(){return"nr-mask"},get blockSelector(){return e.blockSelector},set blockSelector(t){e.blockSelector+=",".concat(t)},get maskInputOptions(){return e.maskInputOptions},set maskInputOptions(t){e.maskInputOptions={...t,password:!0}}},spa:{enabled:!0,harvestTimeSeconds:10}}},f={};function l(e){if(!e)throw new Error("All configuration objects require an agent identifier!");if(!f[e])throw new Error("Configuration for ".concat(e," was never set"));return f[e]}function h(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");f[e]=(0,i.D)(t,d()),(0,n.Qy)(e,f[e],"config")}function g(e,t){if(!e)throw new Error("All configuration objects require an agent identifier!");var r=l(e);if(r){for(var n=t.split("."),i=0;i {r.d(t,{D:()=>i});var n=r(50);function i(e,t){try{if(!e||"object"!=typeof e)return(0,n.Z)("Setting a Configurable requires an object as input");if(!t||"object"!=typeof t)return(0,n.Z)("Setting a Configurable requires a model to set its initial properties");const r=Object.create(Object.getPrototypeOf(t),Object.getOwnPropertyDescriptors(t)),o=0===Object.keys(r).length?e:r;for(let a in o)if(void 0!==e[a])try{"object"==typeof e[a]&&"object"==typeof t[a]?r[a]=i(e[a],t[a]):r[a]=e[a]}catch(e){(0,n.Z)("An error occurred while setting a property of a Configurable",e)}return r}catch(e){(0,n.Z)("An error occured while setting a Configurable",e)}}},6818:(e,t,r)=>{r.d(t,{Re:()=>i,gF:()=>o,q4:()=>n});const n="1.236.0",i="PROD",o="CDN"},385:(e,t,r)=>{r.d(t,{FN:()=>a,IF:()=>u,Nk:()=>f,Tt:()=>s,_A:()=>o,il:()=>n,pL:()=>c,v6:()=>i,w1:()=>d});const n="undefined"!=typeof window&&!!window.document,i="undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self.navigator instanceof WorkerNavigator||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis.navigator instanceof WorkerNavigator),o=n?window:"undefined"!=typeof WorkerGlobalScope&&("undefined"!=typeof self&&self instanceof WorkerGlobalScope&&self||"undefined"!=typeof globalThis&&globalThis instanceof WorkerGlobalScope&&globalThis),a=""+o?.location,s=/iPad|iPhone|iPod/.test(navigator.userAgent),c=s&&"undefined"==typeof SharedWorker,u=(()=>{const e=navigator.userAgent.match(/Firefox[/\s](\d+\.\d+)/);return Array.isArray(e)&&e.length>=2?+e[1]:0})(),d=Boolean(n&&window.document.documentMode),f=!!navigator.sendBeacon},1117:(e,t,r)=>{r.d(t,{w:()=>o});var n=r(50);const i={agentIdentifier:"",ee:void 0};class o{constructor(e){try{if("object"!=typeof e)return(0,n.Z)("shared context requires an object as input");this.sharedContext={},Object.assign(this.sharedContext,i),Object.entries(e).forEach((e=>{let[t,r]=e;Object.keys(i).includes(t)&&(this.sharedContext[t]=r)}))}catch(e){(0,n.Z)("An error occured while setting SharedContext",e)}}}},8e3:(e,t,r)=>{r.d(t,{L:()=>d,R:()=>c});var n=r(2177),i=r(1284),o=r(4322),a=r(3325);const s={};function c(e,t){const r={staged:!1,priority:a.p[t]||0};u(e),s[e].get(t)||s[e].set(t,r)}function u(e){e&&(s[e]||(s[e]=new Map))}function d(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:"",t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:"feature";if(u(e),!e||!s[e].get(t))return a(t);s[e].get(t).staged=!0;const r=[...s[e]];function a(t){const r=e?n.ee.get(e):n.ee,a=o.X.handlers;if(r.backlog&&a){var s=r.backlog[t],c=a[t];if(c){for(var u=0;s&&u {let[t,r]=e;return r.staged}))&&(r.sort(((e,t)=>e[1].priority-t[1].priority)),r.forEach((e=>{let[t]=e;a(t)})))}function f(e,t){var r=e[1];(0,i.D)(t[r],(function(t,r){var n=e[0];if(r[0]===n){var i=r[1],o=e[3],a=e[2];i.apply(o,a)}}))}},2177:(e,t,r)=>{r.d(t,{c:()=>f,ee:()=>u});var n=r(8632),i=r(2210),o=r(1284),a=r(5763),s="nr@context";let c=(0,n.fP)();var u;function d(){}function f(e){return(0,i.X)(e,s,l)}function l(){return new d}function h(){u.aborted=!0,u.backlog={}}c.ee?u=c.ee:(u=function e(t,r){var n={},c={},f={},g=!1;try{g=16===r.length&&(0,a.OP)(r).isolatedBacklog}catch(e){}var p={on:b,addEventListener:b,removeEventListener:y,emit:v,get:x,listeners:w,context:m,buffer:A,abort:h,aborted:!1,isBuffering:E,debugId:r,backlog:g?{}:t&&"object"==typeof t.backlog?t.backlog:{}};return p;function m(e){return e&&e instanceof d?e:e?(0,i.X)(e,s,l):l()}function v(e,r,n,i,o){if(!1!==o&&(o=!0),!u.aborted||i){t&&o&&t.emit(e,r,n);for(var a=m(n),s=w(e),d=s.length,f=0;fn,p:()=>i});var n=r(2177).ee.get("handle");function i(e,t,r,i,o){o?(o.buffer([e],i),o.emit(e,t,r)):(n.buffer([e],i),n.emit(e,t,r))}},4322:(e,t,r)=>{r.d(t,{X:()=>o});var n=r(5546);o.on=a;var i=o.handlers={};function o(e,t,r,o){a(o||n.E,i,e,t,r)}function a(e,t,r,i,o){o||(o="feature"),e||(e=n.E);var a=t[o]=t[o]||{};(a[r]=a[r]||[]).push([e,i])}},3239:(e,t,r)=>{r.d(t,{bP:()=>s,iz:()=>c,m$:()=>a});var n=r(385);let i=!1,o=!1;try{const e={get passive(){return i=!0,!1},get signal(){return o=!0,!1}};n._A.addEventListener("test",null,e),n._A.removeEventListener("test",null,e)}catch(e){}function a(e,t){return i||o?{capture:!!e,passive:i,signal:t}:!!e}function s(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;window.addEventListener(e,t,a(r,n))}function c(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2],n=arguments.length>3?arguments[3]:void 0;document.addEventListener(e,t,a(r,n))}},4402:(e,t,r)=>{r.d(t,{Ht:()=>u,M:()=>c,Rl:()=>a,ky:()=>s});var n=r(385);const i="xxxxxxxx-xxxx-4xxx-yxxx-xxxxxxxxxxxx";function o(e,t){return e?15&e[t]:16*Math.random()|0}function a(){const e=n._A?.crypto||n._A?.msCrypto;let t,r=0;return e&&e.getRandomValues&&(t=e.getRandomValues(new Uint8Array(31))),i.split("").map((e=>"x"===e?o(t,++r).toString(16):"y"===e?(3&o()|8).toString(16):e)).join("")}function s(e){const t=n._A?.crypto||n._A?.msCrypto;let r,i=0;t&&t.getRandomValues&&(r=t.getRandomValues(new Uint8Array(31)));const a=[];for(var s=0;s {r.d(t,{Bq:()=>n,Hb:()=>o,oD:()=>i});const n="NRBA",i=144e5,o=18e5},7894:(e,t,r)=>{function n(){return Math.round(performance.now())}r.d(t,{z:()=>n})},7243:(e,t,r)=>{r.d(t,{e:()=>o});var n=r(385),i={};function o(e){if(e in i)return i[e];if(0===(e||"").indexOf("data:"))return{protocol:"data"};let t;var r=n._A?.location,o={};if(n.il)t=document.createElement("a"),t.href=e;else try{t=new URL(e,r.href)}catch(e){return o}o.port=t.port;var a=t.href.split("://");!o.port&&a[1]&&(o.port=a[1].split("/")[0].split("@").pop().split(":")[1]),o.port&&"0"!==o.port||(o.port="https"===a[0]?"443":"80"),o.hostname=t.hostname||r.hostname,o.pathname=t.pathname,o.protocol=a[0],"/"!==o.pathname.charAt(0)&&(o.pathname="/"+o.pathname);var s=!t.protocol||":"===t.protocol||t.protocol===r.protocol,c=t.hostname===r.hostname&&t.port===r.port;return o.sameOrigin=s&&(!t.hostname||c),"/"===o.pathname&&(i[e]=o),o}},50:(e,t,r)=>{function n(e,t){"function"==typeof console.warn&&(console.warn("New Relic: ".concat(e)),t&&console.warn(t))}r.d(t,{Z:()=>n})},2587:(e,t,r)=>{r.d(t,{N:()=>c,T:()=>u});var n=r(2177),i=r(5546),o=r(8e3),a=r(3325);const s={stn:[a.D.sessionTrace],err:[a.D.jserrors,a.D.metrics],ins:[a.D.pageAction],spa:[a.D.spa],sr:[a.D.sessionReplay,a.D.sessionTrace]};function c(e,t){const r=n.ee.get(t);e&&"object"==typeof e&&(Object.entries(e).forEach((e=>{let[t,n]=e;void 0===u[t]&&(s[t]?s[t].forEach((e=>{n?(0,i.p)("feat-"+t,[],void 0,e,r):(0,i.p)("block-"+t,[],void 0,e,r),(0,i.p)("rumresp-"+t,[Boolean(n)],void 0,e,r)})):n&&(0,i.p)("feat-"+t,[],void 0,void 0,r),u[t]=Boolean(n))})),Object.keys(s).forEach((e=>{void 0===u[e]&&(s[e]?.forEach((t=>(0,i.p)("rumresp-"+e,[!1],void 0,t,r))),u[e]=!1)})),(0,o.L)(t,a.D.pageViewEvent))}const u={}},2210:(e,t,r)=>{r.d(t,{X:()=>i});var n=Object.prototype.hasOwnProperty;function i(e,t,r){if(n.call(e,t))return e[t];var i=r();if(Object.defineProperty&&Object.keys)try{return Object.defineProperty(e,t,{value:i,writable:!0,enumerable:!1}),i}catch(e){}return e[t]=i,i}},1284:(e,t,r)=>{r.d(t,{D:()=>n});const n=(e,t)=>Object.entries(e||{}).map((e=>{let[r,n]=e;return t(r,n)}))},4351:(e,t,r)=>{r.d(t,{P:()=>o});var n=r(2177);const i=()=>{const e=new WeakSet;return(t,r)=>{if("object"==typeof r&&null!==r){if(e.has(r))return;e.add(r)}return r}};function o(e){try{return JSON.stringify(e,i())}catch(e){try{n.ee.emit("internal-error",[e])}catch(e){}}}},3960:(e,t,r)=>{r.d(t,{K:()=>a,b:()=>o});var n=r(3239);function i(){return"undefined"==typeof document||"complete"===document.readyState}function o(e,t){if(i())return e();(0,n.bP)("load",e,t)}function a(e){if(i())return e();(0,n.iz)("DOMContentLoaded",e)}},8632:(e,t,r)=>{r.d(t,{EZ:()=>u,Qy:()=>c,ce:()=>o,fP:()=>a,gG:()=>d,mF:()=>s});var n=r(7894),i=r(385);const o={beacon:"bam.nr-data.net",errorBeacon:"bam.nr-data.net"};function a(){return i._A.NREUM||(i._A.NREUM={}),void 0===i._A.newrelic&&(i._A.newrelic=i._A.NREUM),i._A.NREUM}function s(){let e=a();return e.o||(e.o={ST:i._A.setTimeout,SI:i._A.setImmediate,CT:i._A.clearTimeout,XHR:i._A.XMLHttpRequest,REQ:i._A.Request,EV:i._A.Event,PR:i._A.Promise,MO:i._A.MutationObserver,FETCH:i._A.fetch}),e}function c(e,t,r){let i=a();const o=i.initializedAgents||{},s=o[e]||{};return Object.keys(s).length||(s.initializedAt={ms:(0,n.z)(),date:new Date}),i.initializedAgents={...o,[e]:{...s,[r]:t}},i}function u(e,t){a()[e]=t}function d(){return function(){let e=a();const t=e.info||{};e.info={beacon:o.beacon,errorBeacon:o.errorBeacon,...t}}(),function(){let e=a();const t=e.init||{};e.init={...t}}(),s(),function(){let e=a();const t=e.loader_config||{};e.loader_config={...t}}(),a()}},7956:(e,t,r)=>{r.d(t,{N:()=>i});var n=r(3239);function i(e){let t=arguments.length>1&&void 0!==arguments[1]&&arguments[1],r=arguments.length>2?arguments[2]:void 0,i=arguments.length>3?arguments[3]:void 0;return void(0,n.iz)("visibilitychange",(function(){if(t)return void("hidden"==document.visibilityState&&e());e(document.visibilityState)}),r,i)}},1214:(e,t,r)=>{r.d(t,{em:()=>v,u5:()=>N,QU:()=>S,_L:()=>I,Gm:()=>L,Lg:()=>M,gy:()=>U,BV:()=>Q,Kf:()=>ee});var n=r(2177);const i="nr@original";var o=Object.prototype.hasOwnProperty,a=!1;function s(e,t){return e||(e=n.ee),r.inPlace=function(e,t,n,i,o){n||(n="");var a,s,c,u="-"===n.charAt(0);for(c=0;c 2?n-2:0),o=2;o {r(A[T],e,w),r(E[T],e,w)})),r(l._A,"fetch",y),t.on(y+"end",(function(e,r){var n=this;if(r){var i=r.headers.get("content-length");null!==i&&(n.rxSize=i),t.emit(y+"done",[null,r],n)}else t.emit(y+"done",[e],n)})),t}const O={},j=["pushState","replaceState"];function S(e){const t=function(e){return(e||n.ee).get("history")}(e);return!l.il||O[t.debugId]++||(O[t.debugId]=1,s(t).inPlace(window.history,j,"-")),t}var P=r(3239);const C={},R=["appendChild","insertBefore","replaceChild"];function I(e){const t=function(e){return(e||n.ee).get("jsonp")}(e);if(!l.il||C[t.debugId])return t;C[t.debugId]=!0;var r=s(t),i=/[?&](?:callback|cb)=([^&#]+)/,o=/(.*)\.([^.]+)/,a=/^(\w+)(\.|$)(.*)$/;function c(e,t){var r=e.match(a),n=r[1],i=r[3];return i?c(i,t[n]):t[n]}return r.inPlace(Node.prototype,R,"dom-"),t.on("dom-start",(function(e){!function(e){if(!e||"string"!=typeof e.nodeName||"script"!==e.nodeName.toLowerCase())return;if("function"!=typeof e.addEventListener)return;var n=(a=e.src,s=a.match(i),s?s[1]:null);var a,s;if(!n)return;var u=function(e){var t=e.match(o);if(t&&t.length>=3)return{key:t[2],parent:c(t[1],window)};return{key:e,parent:window}}(n);if("function"!=typeof u.parent[u.key])return;var d={};function f(){t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}function l(){t.emit("jsonp-error",[],d),t.emit("jsonp-end",[],d),e.removeEventListener("load",f,(0,P.m$)(!1)),e.removeEventListener("error",l,(0,P.m$)(!1))}r.inPlace(u.parent,[u.key],"cb-",d),e.addEventListener("load",f,(0,P.m$)(!1)),e.addEventListener("error",l,(0,P.m$)(!1)),t.emit("new-jsonp",[e.src],d)}(e[0])})),t}var k=r(5763);const H={};function L(e){const t=function(e){return(e||n.ee).get("mutation")}(e);if(!l.il||H[t.debugId])return t;H[t.debugId]=!0;var r=s(t),i=k.Yu.MO;return i&&(window.MutationObserver=function(e){return this instanceof i?new i(r(e,"fn-")):i.apply(this,arguments)},MutationObserver.prototype=i.prototype),t}const z={};function M(e){const t=function(e){return(e||n.ee).get("promise")}(e);if(z[t.debugId])return t;z[t.debugId]=!0;var r=n.c,o=s(t),a=k.Yu.PR;return a&&function(){function e(r){var n=t.context(),i=o(r,"executor-",n,null,!1);const s=Reflect.construct(a,[i],e);return t.context(s).getCtx=function(){return n},s}l._A.Promise=e,Object.defineProperty(e,"name",{value:"Promise"}),e.toString=function(){return a.toString()},Object.setPrototypeOf(e,a),["all","race"].forEach((function(r){const n=a[r];e[r]=function(e){let i=!1;[...e||[]].forEach((e=>{this.resolve(e).then(a("all"===r),a(!1))}));const o=n.apply(this,arguments);return o;function a(e){return function(){t.emit("propagate",[null,!i],o,!1,!1),i=i||!e}}}})),["resolve","reject"].forEach((function(r){const n=a[r];e[r]=function(e){const r=n.apply(this,arguments);return e!==r&&t.emit("propagate",[e,!0],r,!1,!1),r}})),e.prototype=a.prototype;const n=a.prototype.then;a.prototype.then=function(){var e=this,i=r(e);i.promise=e;for(var a=arguments.length,s=new Array(a),c=0;c e())),t};function m(e,t){i.inPlace(t,["onreadystatechange"],"fn-",E)}function b(){var e=this,t=r.context(e);e.readyState>3&&!t.resolved&&(t.resolved=!0,r.emit("xhr-resolved",[],e)),i.inPlace(e,f,"fn-",E)}if(function(e,t){for(var r in e)t[r]=e[r]}(o,p),p.prototype=o.prototype,i.inPlace(p.prototype,J,"-xhr-",E),r.on("send-xhr-start",(function(e,t){m(e,t),function(e){h.push(e),a&&(y?y.then(A):u?u(A):(w=-w,x.data=w))}(t)})),r.on("open-xhr-start",m),a){var y=c&&c.resolve();if(!u&&!c){var w=1,x=document.createTextNode(w);new a(A).observe(x,{characterData:!0})}}else t.on("fn-end",(function(e){e[0]&&e[0].type===d||A()}));function A(){for(var e=0;e {r.d(t,{t:()=>n});const n=r(3325).D.ajax},6660:(e,t,r)=>{r.d(t,{A:()=>i,t:()=>n});const n=r(3325).D.jserrors,i="nr@seenError"},3081:(e,t,r)=>{r.d(t,{gF:()=>o,mY:()=>i,t9:()=>n,vz:()=>s,xS:()=>a});const n=r(3325).D.metrics,i="sm",o="cm",a="storeSupportabilityMetrics",s="storeEventMetrics"},4649:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageAction},7633:(e,t,r)=>{r.d(t,{Dz:()=>i,OJ:()=>a,qw:()=>o,t9:()=>n});const n=r(3325).D.pageViewEvent,i="firstbyte",o="domcontent",a="windowload"},9251:(e,t,r)=>{r.d(t,{t:()=>n});const n=r(3325).D.pageViewTiming},3614:(e,t,r)=>{r.d(t,{BST_RESOURCE:()=>i,END:()=>s,FEATURE_NAME:()=>n,FN_END:()=>u,FN_START:()=>c,PUSH_STATE:()=>d,RESOURCE:()=>o,START:()=>a});const n=r(3325).D.sessionTrace,i="bstResource",o="resource",a="-start",s="-end",c="fn"+a,u="fn"+s,d="pushState"},7836:(e,t,r)=>{r.d(t,{BODY:()=>A,CB_END:()=>E,CB_START:()=>u,END:()=>x,FEATURE_NAME:()=>i,FETCH:()=>_,FETCH_BODY:()=>v,FETCH_DONE:()=>m,FETCH_START:()=>p,FN_END:()=>c,FN_START:()=>s,INTERACTION:()=>l,INTERACTION_API:()=>d,INTERACTION_EVENTS:()=>o,JSONP_END:()=>b,JSONP_NODE:()=>g,JS_TIME:()=>T,MAX_TIMER_BUDGET:()=>a,REMAINING:()=>f,SPA_NODE:()=>h,START:()=>w,originalSetTimeout:()=>y});var n=r(5763);const i=r(3325).D.spa,o=["click","submit","keypress","keydown","keyup","change"],a=999,s="fn-start",c="fn-end",u="cb-start",d="api-ixn-",f="remaining",l="interaction",h="spaNode",g="jsonpNode",p="fetch-start",m="fetch-done",v="fetch-body-",b="jsonp-end",y=n.Yu.ST,w="-start",x="-end",A="-body",E="cb"+x,T="jsTime",_="fetch"},5938:(e,t,r)=>{r.d(t,{W:()=>o});var n=r(5763),i=r(2177);class o{constructor(e,t,r){this.agentIdentifier=e,this.aggregator=t,this.ee=i.ee.get(e,(0,n.OP)(this.agentIdentifier).isolatedBacklog),this.featureName=r,this.blocked=!1}}},9144:(e,t,r)=>{r.d(t,{j:()=>m});var n=r(3325),i=r(5763),o=r(5546),a=r(2177),s=r(7894),c=r(8e3),u=r(3960),d=r(385),f=r(50),l=r(3081),h=r(8632);function g(){const e=(0,h.gG)();["setErrorHandler","finished","addToTrace","inlineHit","addRelease","addPageAction","setCurrentRouteName","setPageViewName","setCustomAttribute","interaction","noticeError","setUserId"].forEach((t=>{e[t]=function(){for(var r=arguments.length,n=new Array(r),i=0;i 1?r-1:0),i=1;i {e.exposed&&e.api[t]&&o.push(e.api[t](...n))})),o.length>1?o:o[0]}(t,...n)}}))}var p=r(2587);function m(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:{},m=arguments.length>2?arguments[2]:void 0,v=arguments.length>3?arguments[3]:void 0,{init:b,info:y,loader_config:w,runtime:x={loaderType:m},exposed:A=!0}=t;const E=(0,h.gG)();y||(b=E.init,y=E.info,w=E.loader_config),(0,i.Dg)(e,b||{}),(0,i.GE)(e,w||{}),(0,i.sU)(e,x),y.jsAttributes??={},d.v6&&(y.jsAttributes.isWorker=!0),(0,i.CX)(e,y),g();const T=function(e,t){t||(0,c.R)(e,"api");const h={};var g=a.ee.get(e),p=g.get("tracer"),m="api-",v=m+"ixn-";function b(t,r,n,o){const a=(0,i.C5)(e);return null===r?delete a.jsAttributes[t]:(0,i.CX)(e,{...a,jsAttributes:{...a.jsAttributes,[t]:r}}),x(m,n,!0,o||null===r?"session":void 0)(t,r)}function y(){}["setErrorHandler","finished","addToTrace","inlineHit","addRelease"].forEach((e=>h[e]=x(m,e,!0,"api"))),h.addPageAction=x(m,"addPageAction",!0,n.D.pageAction),h.setCurrentRouteName=x(m,"routeName",!0,n.D.spa),h.setPageViewName=function(t,r){if("string"==typeof t)return"/"!==t.charAt(0)&&(t="/"+t),(0,i.OP)(e).customTransaction=(r||"http://custom.transaction")+t,x(m,"setPageViewName",!0)()},h.setCustomAttribute=function(e,t){let r=arguments.length>2&&void 0!==arguments[2]&&arguments[2];if("string"==typeof e){if(["string","number"].includes(typeof t)||null===t)return b(e,t,"setCustomAttribute",r);(0,f.Z)("Failed to execute setCustomAttribute.\nNon-null value must be a string or number type, but a type of was provided."))}else(0,f.Z)("Failed to execute setCustomAttribute.\nName must be a string type, but a type of was provided."))},h.setUserId=function(e){if("string"==typeof e||null===e)return b("enduser.id",e,"setUserId",!0);(0,f.Z)("Failed to execute setUserId.\nNon-null value must be a string type, but a type of was provided."))},h.interaction=function(){return(new y).get()};var w=y.prototype={createTracer:function(e,t){var r={},i=this,a="function"==typeof t;return(0,o.p)(v+"tracer",[(0,s.z)(),e,r],i,n.D.spa,g),function(){if(p.emit((a?"":"no-")+"fn-start",[(0,s.z)(),i,a],r),a)try{return t.apply(this,arguments)}catch(e){throw p.emit("fn-err",[arguments,this,"string"==typeof e?new Error(e):e],r),e}finally{p.emit("fn-end",[(0,s.z)()],r)}}}};function x(e,t,r,i){return function(){return(0,o.p)(l.xS,["API/"+t+"/called"],void 0,n.D.metrics,g),i&&(0,o.p)(e+t,[(0,s.z)(),...arguments],r?null:this,i,g),r?void 0:this}}function A(){r.e(439).then(r.bind(r,7438)).then((t=>{let{setAPI:r}=t;r(e),(0,c.L)(e,"api")})).catch((()=>(0,f.Z)("Downloading runtime APIs failed...")))}return["actionText","setName","setAttribute","save","ignore","onEnd","getContext","end","get"].forEach((e=>{w[e]=x(v,e,void 0,n.D.spa)})),h.noticeError=function(e,t){"string"==typeof e&&(e=new Error(e)),(0,o.p)(l.xS,["API/noticeError/called"],void 0,n.D.metrics,g),(0,o.p)("err",[e,(0,s.z)(),!1,t],void 0,n.D.jserrors,g)},d.il?(0,u.b)((()=>A()),!0):A(),h}(e,v);return(0,h.Qy)(e,T,"api"),(0,h.Qy)(e,A,"exposed"),(0,h.EZ)("activatedFeatures",p.T),T}},3325:(e,t,r)=>{r.d(t,{D:()=>n,p:()=>i});const n={ajax:"ajax",jserrors:"jserrors",metrics:"metrics",pageAction:"page_action",pageViewEvent:"page_view_event",pageViewTiming:"page_view_timing",sessionReplay:"session_replay",sessionTrace:"session_trace",spa:"spa"},i={[n.pageViewEvent]:1,[n.pageViewTiming]:2,[n.metrics]:3,[n.jserrors]:4,[n.ajax]:5,[n.sessionTrace]:6,[n.pageAction]:7,[n.spa]:8,[n.sessionReplay]:9}}},n={};function i(e){var t=n[e];if(void 0!==t)return t.exports;var o=n[e]={exports:{}};return r[e](o,o.exports,i),o.exports}i.m=r,i.d=(e,t)=>{for(var r in t)i.o(t,r)&&!i.o(e,r)&&Object.defineProperty(e,r,{enumerable:!0,get:t[r]})},i.f={},i.e=e=>Promise.all(Object.keys(i.f).reduce(((t,r)=>(i.f[r](e,t),t)),[])),i.u=e=>(({78:"page_action-aggregate",147:"metrics-aggregate",242:"session-manager",317:"jserrors-aggregate",348:"page_view_timing-aggregate",412:"lazy-feature-loader",439:"async-api",538:"recorder",590:"session_replay-aggregate",675:"compressor",733:"session_trace-aggregate",786:"page_view_event-aggregate",873:"spa-aggregate",898:"ajax-aggregate"}[e]||e)+"."+{78:"ac76d497",147:"3dc53903",148:"1a20d5fe",242:"2a64278a",317:"49e41428",348:"bd6de33a",412:"2f55ce66",439:"30bd804e",538:"1b18459f",590:"cf0efb30",675:"ae9f91a8",733:"83105561",786:"06482edd",860:"03a8b7a5",873:"e6b09d52",898:"998ef92b"}[e]+"-1.236.0.min.js"),i.o=(e,t)=>Object.prototype.hasOwnProperty.call(e,t),e={},t="NRBA:",i.l=(r,n,o,a)=>{if(e[r])e[r].push(n);else{var s,c;if(void 0!==o)for(var u=document.getElementsByTagName("script"),d=0;d {s.onerror=s.onload=null,clearTimeout(h);var i=e[r];if(delete e[r],s.parentNode&&s.parentNode.removeChild(s),i&&i.forEach((e=>e(n))),t)return t(n)},h=setTimeout(l.bind(null,void 0,{type:"timeout",target:s}),12e4);s.onerror=l.bind(null,s.onerror),s.onload=l.bind(null,s.onload),c&&document.head.appendChild(s)}},i.r=e=>{"undefined"!=typeof Symbol&&Symbol.toStringTag&&Object.defineProperty(e,Symbol.toStringTag,{value:"Module"}),Object.defineProperty(e,"__esModule",{value:!0})},i.j=364,i.p="https://js-agent.newrelic.com/",(()=>{var e={364:0,953:0};i.f.j=(t,r)=>{var n=i.o(e,t)?e[t]:void 0;if(0!==n)if(n)r.push(n[2]);else{var o=new Promise(((r,i)=>n=e[t]=[r,i]));r.push(n[2]=o);var a=i.p+i.u(t),s=new Error;i.l(a,(r=>{if(i.o(e,t)&&(0!==(n=e[t])&&(e[t]=void 0),n)){var o=r&&("load"===r.type?"missing":r.type),a=r&&r.target&&r.target.src;s.message="Loading chunk "+t+" failed.\n("+o+": "+a+")",s.name="ChunkLoadError",s.type=o,s.request=a,n[1](s)}}),"chunk-"+t,t)}};var t=(t,r)=>{var n,o,[a,s,c]=r,u=0;if(a.some((t=>0!==e[t]))){for(n in s)i.o(s,n)&&(i.m[n]=s[n]);if(c)c(i)}for(t&&t(r);u {i.r(o);var e=i(3325),t=i(5763);const r=Object.values(e.D);function n(e){const n={};return r.forEach((r=>{n[r]=function(e,r){return!1!==(0,t.Mt)(r,"".concat(e,".enabled"))}(r,e)})),n}var a=i(9144);var s=i(5546),c=i(385),u=i(8e3),d=i(5938),f=i(3960),l=i(50);class h extends d.W{constructor(e,t,r){let n=!(arguments.length>3&&void 0!==arguments[3])||arguments[3];super(e,t,r),this.auto=n,this.abortHandler,this.featAggregate,this.onAggregateImported,n&&(0,u.R)(e,r)}importAggregator(){let e=arguments.length>0&&void 0!==arguments[0]?arguments[0]:{};if(this.featAggregate||!this.auto)return;const r=c.il&&!0===(0,t.Mt)(this.agentIdentifier,"privacy.cookies_enabled");let n;this.onAggregateImported=new Promise((e=>{n=e}));const o=async()=>{let t;try{if(r){const{setupAgentSession:e}=await Promise.all([i.e(860),i.e(242)]).then(i.bind(i,3228));t=e(this.agentIdentifier)}}catch(e){(0,l.Z)("A problem occurred when starting up session manager. This page will not start or extend any session.",e)}try{if(!this.shouldImportAgg(this.featureName,t))return void(0,u.L)(this.agentIdentifier,this.featureName);const{lazyFeatureLoader:r}=await i.e(412).then(i.bind(i,8582)),{Aggregate:o}=await r(this.featureName,"aggregate");this.featAggregate=new o(this.agentIdentifier,this.aggregator,e),n(!0)}catch(e){(0,l.Z)("Downloading and initializing ".concat(this.featureName," failed..."),e),this.abortHandler?.(),n(!1)}};c.il?(0,f.b)((()=>o()),!0):o()}shouldImportAgg(r,n){return r!==e.D.sessionReplay||!1!==(0,t.Mt)(this.agentIdentifier,"session_trace.enabled")&&(!!n?.isNew||!!n?.state.sessionReplay)}}var g=i(7633),p=i(7894);class m extends h{static featureName=g.t9;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];if(super(r,n,g.t9,i),("undefined"==typeof PerformanceNavigationTiming||c.Tt)&&"undefined"!=typeof PerformanceTiming){const n=(0,t.OP)(r);n[g.Dz]=Math.max(Date.now()-n.offset,0),(0,f.K)((()=>n[g.qw]=Math.max((0,p.z)()-n[g.Dz],0))),(0,f.b)((()=>{const t=(0,p.z)();n[g.OJ]=Math.max(t-n[g.Dz],0),(0,s.p)("timing",["load",t],void 0,e.D.pageViewTiming,this.ee)}))}this.importAggregator()}}var v=i(1117),b=i(1284);class y extends v.w{constructor(e){super(e),this.aggregatedData={}}store(e,t,r,n,i){var o=this.getBucket(e,t,r,i);return o.metrics=function(e,t){t||(t={count:0});return t.count+=1,(0,b.D)(e,(function(e,r){t[e]=w(r,t[e])})),t}(n,o.metrics),o}merge(e,t,r,n,i){var o=this.getBucket(e,t,n,i);if(o.metrics){var a=o.metrics;a.count+=r.count,(0,b.D)(r,(function(e,t){if("count"!==e){var n=a[e],i=r[e];i&&!i.c?a[e]=w(i.t,n):a[e]=function(e,t){if(!t)return e;t.c||(t=x(t.t));return t.min=Math.min(e.min,t.min),t.max=Math.max(e.max,t.max),t.t+=e.t,t.sos+=e.sos,t.c+=e.c,t}(i,a[e])}}))}else o.metrics=r}storeMetric(e,t,r,n){var i=this.getBucket(e,t,r);return i.stats=w(n,i.stats),i}getBucket(e,t,r,n){this.aggregatedData[e]||(this.aggregatedData[e]={});var i=this.aggregatedData[e][t];return i||(i=this.aggregatedData[e][t]={params:r||{}},n&&(i.custom=n)),i}get(e,t){return t?this.aggregatedData[e]&&this.aggregatedData[e][t]:this.aggregatedData[e]}take(e){for(var t={},r="",n=!1,i=0;i t.max&&(t.max=e),e 2&&void 0!==arguments[2])||arguments[2];super(e,r,j.t,n),c.il&&((0,t.OP)(e).initHidden=Boolean("hidden"===document.visibilityState),(0,N.N)((()=>(0,s.p)("docHidden",[(0,p.z)()],void 0,j.t,this.ee)),!0),(0,O.bP)("pagehide",(()=>(0,s.p)("winPagehide",[(0,p.z)()],void 0,j.t,this.ee))),this.importAggregator())}}var P=i(3081);class C extends h{static featureName=P.t9;constructor(e,t){let r=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(e,t,P.t9,r),this.importAggregator()}}var R,I=i(2210),k=i(1214),H=i(2177),L={};try{R=localStorage.getItem("__nr_flags").split(","),console&&"function"==typeof console.log&&(L.console=!0,-1!==R.indexOf("dev")&&(L.dev=!0),-1!==R.indexOf("nr_dev")&&(L.nrDev=!0))}catch(e){}function z(e){try{L.console&&z(e)}catch(e){}}L.nrDev&&H.ee.on("internal-error",(function(e){z(e.stack)})),L.dev&&H.ee.on("fn-err",(function(e,t,r){z(r.stack)})),L.dev&&(z("NR AGENT IN DEVELOPMENT MODE"),z("flags: "+(0,b.D)(L,(function(e,t){return e})).join(", ")));var M=i(6660);class B extends h{static featureName=M.t;constructor(r,n){let i=!(arguments.length>2&&void 0!==arguments[2])||arguments[2];super(r,n,M.t,i),this.skipNext=0;try{this.removeOnAbort=new AbortController}catch(e){}const o=this;o.ee.on("fn-start",(function(e,t,r){o.abortHandler&&(o.skipNext+=1)})),o.ee.on("fn-err",(function(t,r,n){o.abortHandler&&!n[M.A]&&((0,I.X)(n,M.A,(function(){return!0})),this.thrown=!0,(0,s.p)("err",[n,(0,p.z)()],void 0,e.D.jserrors,o.ee))})),o.ee.on("fn-end",(function(){o.abortHandler&&!this.thrown&&o.skipNext>0&&(o.skipNext-=1)})),o.ee.on("internal-error",(function(t){(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,o.ee)})),this.origOnerror=c._A.onerror,c._A.onerror=this.onerrorHandler.bind(this),c._A.addEventListener("unhandledrejection",(t=>{const r=function(e){let t="Unhandled Promise Rejection: ";if(e instanceof Error)try{return e.message=t+e.message,e}catch(t){return e}if(void 0===e)return new Error(t);try{return new Error(t+(0,D.P)(e))}catch(e){return new Error(t)}}(t.reason);(0,s.p)("err",[r,(0,p.z)(),!1,{unhandledPromiseRejection:1}],void 0,e.D.jserrors,this.ee)}),(0,O.m$)(!1,this.removeOnAbort?.signal)),(0,k.gy)(this.ee),(0,k.BV)(this.ee),(0,k.em)(this.ee),(0,t.OP)(r).xhrWrappable&&(0,k.Kf)(this.ee),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}onerrorHandler(t,r,n,i,o){"function"==typeof this.origOnerror&&this.origOnerror(...arguments);try{this.skipNext?this.skipNext-=1:(0,s.p)("err",[o||new F(t,r,n),(0,p.z)()],void 0,e.D.jserrors,this.ee)}catch(t){try{(0,s.p)("ierr",[t,(0,p.z)(),!0],void 0,e.D.jserrors,this.ee)}catch(e){}}return!1}}function F(e,t,r){this.message=e||"Uncaught error with no additional information",this.sourceURL=t,this.line=r}let U=1;const q="nr@id";function G(e){const t=typeof e;return!e||"object"!==t&&"function"!==t?-1:e===c._A?0:(0,I.X)(e,q,(function(){return U++}))}function V(e){if("string"==typeof e&&e.length)return e.length;if("object"==typeof e){if("undefined"!=typeof ArrayBuffer&&e instanceof ArrayBuffer&&e.byteLength)return e.byteLength;if("undefined"!=typeof Blob&&e instanceof Blob&&e.size)return e.size;if(!("undefined"!=typeof FormData&&e instanceof FormData))try{return(0,D.P)(e).length}catch(e){return}}}var X=i(7243);class W{constructor(e){this.agentIdentifier=e,this.generateTracePayload=this.generateTracePayload.bind(this),this.shouldGenerateTrace=this.shouldGenerateTrace.bind(this)}generateTracePayload(e){if(!this.shouldGenerateTrace(e))return null;var r=(0,t.DL)(this.agentIdentifier);if(!r)return null;var n=(r.accountID||"").toString()||null,i=(r.agentID||"").toString()||null,o=(r.trustKey||"").toString()||null;if(!n||!i)return null;var a=(0,_.M)(),s=(0,_.Ht)(),c=Date.now(),u={spanId:a,traceId:s,timestamp:c};return(e.sameOrigin||this.isAllowedOrigin(e)&&this.useTraceContextHeadersForCors())&&(u.traceContextParentHeader=this.generateTraceContextParentHeader(a,s),u.traceContextStateHeader=this.generateTraceContextStateHeader(a,c,n,i,o)),(e.sameOrigin&&!this.excludeNewrelicHeader()||!e.sameOrigin&&this.isAllowedOrigin(e)&&this.useNewrelicHeaderForCors())&&(u.newrelicHeader=this.generateTraceHeader(a,s,c,n,i,o)),u}generateTraceContextParentHeader(e,t){return"00-"+t+"-"+e+"-01"}generateTraceContextStateHeader(e,t,r,n,i){return i+"@nr=0-1-"+r+"-"+n+"-"+e+"----"+t}generateTraceHeader(e,t,r,n,i,o){if(!("function"==typeof c._A?.btoa))return null;var a={v:[0,1],d:{ty:"Browser",ac:n,ap:i,id:e,tr:t,ti:r}};return o&&n!==o&&(a.d.tk=o),btoa((0,D.P)(a))}shouldGenerateTrace(e){return this.isDtEnabled()&&this.isAllowedOrigin(e)}isAllowedOrigin(e){var r=!1,n={};if((0,t.Mt)(this.agentIdentifier,"distributed_tracing")&&(n=(0,t.P_)(this.agentIdentifier).distributed_tracing),e.sameOrigin)r=!0;else if(n.allowed_origins instanceof Array)for(var i=0;i 2&&void 0!==arguments[2])||arguments[2];super(r,n,Z.t,i),(0,t.OP)(r).xhrWrappable&&(this.dt=new W(r),this.handler=(e,t,r,n)=>(0,s.p)(e,t,r,n,this.ee),(0,k.u5)(this.ee),(0,k.Kf)(this.ee),function(r,n,i,o){function a(e){var t=this;t.totalCbs=0,t.called=0,t.cbTime=0,t.end=E,t.ended=!1,t.xhrGuids={},t.lastSize=null,t.loadCaptureCalled=!1,t.params=this.params||{},t.metrics=this.metrics||{},e.addEventListener("load",(function(r){_(t,e)}),(0,O.m$)(!1)),c.IF||e.addEventListener("progress",(function(e){t.lastSize=e.loaded}),(0,O.m$)(!1))}function s(e){this.params={method:e[0]},T(this,e[1]),this.metrics={}}function u(e,n){var i=(0,t.DL)(r);i.xpid&&this.sameOrigin&&n.setRequestHeader("X-NewRelic-ID",i.xpid);var a=o.generateTracePayload(this.parsedOrigin);if(a){var s=!1;a.newrelicHeader&&(n.setRequestHeader("newrelic",a.newrelicHeader),s=!0),a.traceContextParentHeader&&(n.setRequestHeader("traceparent",a.traceContextParentHeader),a.traceContextStateHeader&&n.setRequestHeader("tracestate",a.traceContextStateHeader),s=!0),s&&(this.dt=a)}}function d(e,t){var r=this.metrics,i=e[0],o=this;if(r&&i){var a=V(i);a&&(r.txSize=a)}this.startTime=(0,p.z)(),this.listener=function(e){try{"abort"!==e.type||o.loadCaptureCalled||(o.params.aborted=!0),("load"!==e.type||o.called===o.totalCbs&&(o.onloadCalled||"function"!=typeof t.onload)&&"function"==typeof o.end)&&o.end(t)}catch(e){try{n.emit("internal-error",[e])}catch(e){}}};for(var s=0;s 1?e[1]=i:e.push(i)}else e[0]&&e[0].headers&&s(e[0].headers,n)&&(this.dt=n);function s(e,t){var r=!1;return t.newrelicHeader&&(e.set("newrelic",t.newrelicHeader),r=!0),t.traceContextParentHeader&&(e.set("traceparent",t.traceContextParentHeader),t.traceContextStateHeader&&e.set("tracestate",t.traceContextStateHeader),r=!0),r}}function x(e,t){this.params={},this.metrics={},this.startTime=(0,p.z)(),this.dt=t,e.length>=1&&(this.target=e[0]),e.length>=2&&(this.opts=e[1]);var r,n=this.opts||{},i=this.target;"string"==typeof i?r=i:"object"==typeof i&&i instanceof Y?r=i.url:c._A?.URL&&"object"==typeof i&&i instanceof URL&&(r=i.href),T(this,r);var o=(""+(i&&i instanceof Y&&i.method||n.method||"GET")).toUpperCase();this.params.method=o,this.txSize=V(n.body)||0}function A(t,r){var n;this.endTime=(0,p.z)(),this.params||(this.params={}),this.params.status=r?r.status:0,"string"==typeof this.rxSize&&this.rxSize.length>0&&(n=+this.rxSize);var o={txSize:this.txSize,rxSize:n,duration:(0,p.z)()-this.startTime};i("xhr",[this.params,o,this.startTime,this.endTime,"fetch"],this,e.D.ajax)}function E(t){var r=this.params,n=this.metrics;if(!this.ended){this.ended=!0;for(var o=0;o 2&&void 0!==arguments[2])||arguments[2];super(e,t,we.t,r),this.importAggregator()}}new class{constructor(e){let t=arguments.length>1&&void 0!==arguments[1]?arguments[1]:(0,_.ky)(16);c._A?(this.agentIdentifier=t,this.sharedAggregator=new y({agentIdentifier:this.agentIdentifier}),this.features={},this.desiredFeatures=new Set(e.features||[]),this.desiredFeatures.add(m),Object.assign(this,(0,a.j)(this.agentIdentifier,e,e.loaderType||"agent")),this.start()):(0,l.Z)("Failed to initial the agent. Could not determine the runtime environment.")}get config(){return{info:(0,t.C5)(this.agentIdentifier),init:(0,t.P_)(this.agentIdentifier),loader_config:(0,t.DL)(this.agentIdentifier),runtime:(0,t.OP)(this.agentIdentifier)}}start(){const t="features";try{const r=n(this.agentIdentifier),i=[...this.desiredFeatures];i.sort(((t,r)=>e.p[t.featureName]-e.p[r.featureName])),i.forEach((t=>{if(r[t.featureName]||t.featureName===e.D.pageViewEvent){const n=function(t){switch(t){case e.D.ajax:return[e.D.jserrors];case e.D.sessionTrace:return[e.D.ajax,e.D.pageViewEvent];case e.D.sessionReplay:return[e.D.sessionTrace];case e.D.pageViewTiming:return[e.D.pageViewEvent];default:return[]}}(t.featureName);n.every((e=>r[e]))||(0,l.Z)("".concat(t.featureName," is enabled but one or more dependent features has been disabled (").concat((0,D.P)(n),"). This may cause unintended consequences or missing data...")),this.features[t.featureName]=new t(this.agentIdentifier,this.sharedAggregator)}})),(0,T.Qy)(this.agentIdentifier,this.features,t)}catch(e){(0,l.Z)("Failed to initialize all enabled instrument classes (agent aborted) -",e);for(const e in this.features)this.features[e].abortHandler?.();const r=(0,T.fP)();return delete r.initializedAgents[this.agentIdentifier]?.api,delete r.initializedAgents[this.agentIdentifier]?.[t],delete this.sharedAggregator,r.ee?.abort(),delete r.ee?.get(this.agentIdentifier),!1}}}({features:[J,m,S,class extends h{static featureName=oe;constructor(t,r){if(super(t,r,oe,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;const n=this.ee;let i;(0,k.QU)(n),this.eventsEE=(0,k.em)(n),this.eventsEE.on(se,(function(e,t){this.bstStart=(0,p.z)()})),this.eventsEE.on(ae,(function(t,r){(0,s.p)("bst",[t[0],r,this.bstStart,(0,p.z)()],void 0,e.D.sessionTrace,n)})),n.on(ce+ne,(function(e){this.time=(0,p.z)(),this.startPath=location.pathname+location.hash})),n.on(ce+ie,(function(t){(0,s.p)("bstHist",[location.pathname+location.hash,this.startPath,this.time],void 0,e.D.sessionTrace,n)}));try{i=new PerformanceObserver((t=>{const r=t.getEntries();(0,s.p)(te,[r],void 0,e.D.sessionTrace,n)})),i.observe({type:re,buffered:!0})}catch(e){}this.importAggregator({resourceObserver:i})}},C,xe,B,class extends h{static featureName=de;constructor(e,r){if(super(e,r,de,!(arguments.length>2&&void 0!==arguments[2])||arguments[2]),!c.il)return;if(!(0,t.OP)(e).xhrWrappable)return;try{this.removeOnAbort=new AbortController}catch(e){}let n,i=0;const o=this.ee.get("tracer"),a=(0,k._L)(this.ee),s=(0,k.Lg)(this.ee),u=(0,k.BV)(this.ee),d=(0,k.Kf)(this.ee),f=this.ee.get("events"),l=(0,k.u5)(this.ee),h=(0,k.QU)(this.ee),g=(0,k.Gm)(this.ee);function m(e,t){h.emit("newURL",[""+window.location,t])}function v(){i++,n=window.location.hash,this[ve]=(0,p.z)()}function b(){i--,window.location.hash!==n&&m(0,!0);var e=(0,p.z)();this[pe]=~~this[pe]+e-this[ve],this[ye]=e}function y(e,t){e.on(t,(function(){this[t]=(0,p.z)()}))}this.ee.on(ve,v),s.on(be,v),a.on(be,v),this.ee.on(ye,b),s.on(ge,b),a.on(ge,b),this.ee.buffer([ve,ye,"xhr-resolved"],this.featureName),f.buffer([ve],this.featureName),u.buffer(["setTimeout"+le,"clearTimeout"+fe,ve],this.featureName),d.buffer([ve,"new-xhr","send-xhr"+fe],this.featureName),l.buffer([me+fe,me+"-done",me+he+fe,me+he+le],this.featureName),h.buffer(["newURL"],this.featureName),g.buffer([ve],this.featureName),s.buffer(["propagate",be,ge,"executor-err","resolve"+fe],this.featureName),o.buffer([ve,"no-"+ve],this.featureName),a.buffer(["new-jsonp","cb-start","jsonp-error","jsonp-end"],this.featureName),y(l,me+fe),y(l,me+"-done"),y(a,"new-jsonp"),y(a,"jsonp-end"),y(a,"cb-start"),h.on("pushState-end",m),h.on("replaceState-end",m),window.addEventListener("hashchange",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("load",m,(0,O.m$)(!0,this.removeOnAbort?.signal)),window.addEventListener("popstate",(function(){m(0,i>1)}),(0,O.m$)(!0,this.removeOnAbort?.signal)),this.abortHandler=this.#e,this.importAggregator()}#e(){this.removeOnAbort?.abort(),this.abortHandler=void 0}}],loaderType:"spa"})})(),window.NRBA=o})(); window.jQuery || document.write(' ') CKEDITOR_BASEPATH='https://f1000research.com/js/vendor/ckeditor/' window.reactTheme = 'research'; window.MathJax = { CommonHTML: { linebreaks: { automatic: true } }, 'HTML-CSS': { linebreaks: { automatic: true } }, SVG: { linebreaks: { automatic: true } }, AuthorInit: function() { MathJax.Hub.Register.MessageHook('End Process', function () { let timeout = false; // holder for timeout id const delay = 250; // delay after event is "complete" to run callback const reflowMath = function() { const dispFormulas = document.querySelectorAll('.disp-formula.panel'); if (!dispFormulas) { return; } for (const dispFormula of dispFormulas) { const child = dispFormula.querySelector('.MathJax_Preview').nextSibling.firstChild; const isMultiline = MathJax.Hub.getAllJax(dispFormula)[0].root.isMultiline; if (dispFormula.offsetWidth < child.offsetWidth || isMultiline) { MathJax.Hub.Queue(['Rerender', MathJax.Hub, dispFormula]); } } }; window.addEventListener('resize', function() { clearTimeout(timeout); // clear the timeout timeout = setTimeout(reflowMath, delay); // start timing for event "completion" }); }); }, }; if (window.location.hash == '#_=_'){ window.location = window.location.href.split('#')[0] } !function(f,b,e,v,n,t,s){if(f.fbq)return;n=f.fbq=function() {n.callMethod? n.callMethod.apply(n,arguments):n.queue.push(arguments)} ;if(!f._fbq)f._fbq=n; n.push=n;n.loaded=!0;n.version='2.0';n.queue=[];t=b.createElement(e);t.async=!0; t.src=v;s=b.getElementsByTagName(e)[0];s.parentNode.insertBefore(t,s)}(window, document,'script','https://connect.facebook.net/en_US/fbevents.js'); fbq('init', '1641728616063202'); fbq('track', "PixelInitialized", {}); (function(h,o,t,j,a,r){ h.hj=h.hj||function(){(h.hj.q=h.hj.q||[]).push(arguments)}; h._hjSettings={hjid:2318163,hjsv:6}; a=o.getElementsByTagName('head')[0]; r=o.createElement('script');r.async=1; r.src=t+h._hjSettings.hjid+j+h._hjSettings.hjsv; a.appendChild(r); })(window,document,'https://static.hotjar.com/c/hotjar-','.js?sv='); search file_upload Submit your research search menu close search Browse Gateways & Collections How to Publish Submit your Research My Submissions Article Guidelines Article Guidelines (New Versions) Open Data, Software and Code Guidelines Open Data and Accessible Source Materials Guidelines (HSS) Open Data, Software and Code Guidelines (PSE) Prepublication Checks Production Process Posters and Slides Guidelines Document Guidelines Article Processing Charges Peer Review Finding Article Reviewers About How it Works For Reviewers Our Advisors Policies Glossary FAQs For Developers Newsroom Contact My Research Submissions Content and Tracking Alerts My Details Sign In file_upload Submit your research { "@context": "https://schema.org", "@type": "ScholarlyArticle", "mainEntityOfPage": { "@type": "WebPage", "@id": "https://f1000research.com/articles/13-432" }, "headline": "Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of...", "datePublished": "2024-05-01T15:24:07", "dateModified": "2024-07-26T16:14:27", "author": [ { "@type": "Person", "name": "Maher Abdallah" }, { "@type": "Person", "name": "Sahar Dandachy" }, { "@type": "Person", "name": "Nour Ahmad" }, { "@type": "Person", "name": "Marwa Sleiman" }, { "@type": "Person", "name": "Rania Mansour" }, { "@type": "Person", "name": "Maha Hoteit" } ], "publisher": { "@type": "Organization", "name": "F1000Research", "logo": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 480, "width": 60 } }, "image": { "@type": "ImageObject", "url": "https://f1000research.com/img/AMP/F1000Research_image.png", "height": 1200, "width": 150 }, "description": " Background Dietary supplements (DS) use among Lebanese patients with type 2 diabetes mellitus (T2DM) increased widely due to the country’s economic and financial situation. This study was conducted (1) to estimate the prevalence of DS use among persons with T2DM amid the escalating economic crisis in Lebanon; (2) to explore the knowledge, attitude, and practice (KAP) of DS use; and (3) to determine any significant association between socio-economic and socio-demographic factors and the use of DS modality Methods A cross-sectional study was conducted during the worst episode of the economic crisis between October and April 2022 on 460 adult patients with T2DM of both sexes. Patients were interviewed using a pre-tested questionnaire. Results Almost 4 out of 10 patients with T2DM in our study were found to be using DS, where 27.6% take multivitamins frequently. One-third of the participants agreed that nutritional supplements are necessary to control diabetes symptoms and complications. Around 41.1% of the participants complained about hypoglycemia and used DS to control their blood sugar levels (56.4%), while the rest used it to improve their health (35.5%) and control their diet (2.2%). The predictors of DS usage were the patient’s level of education [OR=3.9, CI=1.5-10, p=0.003), self-monitoring of blood sugars (OR=4.9, CI=1.68-14.6; p=0.004) and reading the nutrition label [OR=59.3, CI=6.3-55.8, p=0.000]. Conclusion This study estimated the prevalence of DS use and abuse, among persons with diabetes type II and found three significant predictors of DS use among patients with T2DM. Public health experts should encourage healthy discussions and awareness with their patients to comprehend their views regarding DS use. " } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/13-432", "name": "Knowledge, attitudes, and practices of Lebanese patients with type..." } } ] } Home Browse Knowledge, attitudes, and practices of Lebanese patients with type... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Abdallah M, Dandachy S, Ahmad N et al. Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.12688/f1000research.146998.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Revised Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] Maher Abdallah 1 , Sahar Dandachy 2 , Nour Ahmad https://orcid.org/0009-0002-9646-1946 1 , Marwa Sleiman 1 , Rania Mansour https://orcid.org/0000-0002-8084-7150 3 , Maha Hoteit https://orcid.org/0000-0001-7392-4835 1,4 Maher Abdallah 1 , Sahar Dandachy 2 , [...] Nour Ahmad https://orcid.org/0009-0002-9646-1946 1 , Marwa Sleiman 1 , Rania Mansour https://orcid.org/0000-0002-8084-7150 3 , Maha Hoteit https://orcid.org/0000-0001-7392-4835 1,4 PUBLISHED 26 Jul 2024 Author details Author details 1 Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 2 Faculty of Public Health, Section 3, Lebanese University, Tripoli, Lebanon 3 School of Social Sciences and Humanities, Program of Social Work, Doha Institute for Graduate Studies, Doha, Doha, Qatar 4 Food Science Unit, National Council for Scientific Research Lebanon (CNRS-L), Beirut, Lebanon Maher Abdallah Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation Sahar Dandachy Roles: Data Curation, Methodology, Writing – Review & Editing Nour Ahmad Roles: Methodology, Writing – Review & Editing Marwa Sleiman Roles: Methodology, Writing – Review & Editing Rania Mansour Roles: Investigation, Supervision, Writing – Review & Editing Maha Hoteit Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Agriculture, Food and Nutrition gateway. Abstract Background Dietary supplements (DS) use among Lebanese patients with type 2 diabetes mellitus (T2DM) increased widely due to the country’s economic and financial situation. This study was conducted (1) to estimate the prevalence of DS use among persons with T2DM amid the escalating economic crisis in Lebanon; (2) to explore the knowledge, attitude, and practice (KAP) of DS use; and (3) to determine any significant association between socio-economic and socio-demographic factors and the use of DS modality Methods A cross-sectional study was conducted during the worst episode of the economic crisis between October and April 2022 on 460 adult patients with T2DM of both sexes. Patients were interviewed using a pre-tested questionnaire. Results Almost 4 out of 10 patients with T2DM in our study were found to be using DS, where 27.6% take multivitamins frequently. One-third of the participants agreed that nutritional supplements are necessary to control diabetes symptoms and complications. Around 41.1% of the participants complained about hypoglycemia and used DS to control their blood sugar levels (56.4%), while the rest used it to improve their health (35.5%) and control their diet (2.2%). The predictors of DS usage were the patient’s level of education [OR=3.9, CI=1.5-10, p=0.003), self-monitoring of blood sugars (OR=4.9, CI=1.68-14.6; p=0.004) and reading the nutrition label [OR=59.3, CI=6.3-55.8, p=0.000]. Conclusion This study estimated the prevalence of DS use and abuse, among persons with diabetes type II and found three significant predictors of DS use among patients with T2DM. Public health experts should encourage healthy discussions and awareness with their patients to comprehend their views regarding DS use. READ ALL READ LESS Keywords Lebanon, type 2 diabetes, KAP, dietary supplements Corresponding Author(s) Rania Mansour ( [email protected] ) Maha Hoteit ( [email protected] ) Close Corresponding authors: Rania Mansour, Maha Hoteit Competing interests: No competing interests were disclosed. Grant information: Open access funding provided by the Qatar National Library. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Copyright: © 2024 Abdallah M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Abdallah M, Dandachy S, Ahmad N et al. Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.12688/f1000research.146998.2 ) First published: 01 May 2024, 13 :432 ( https://doi.org/10.12688/f1000research.146998.1 ) Latest published: 26 Jul 2024, 13 :432 ( https://doi.org/10.12688/f1000research.146998.2 ) Revised Amendments from Version 1 According to reviewer 1 and 2: - No change was made in the title and abstract of the manuscript. - Changes are made in the “Introduction” where specific information about the rationale of the study, the global context of dietary use among patients with type 2 diabetes and the national use of dietary supplements were added. - In addition, the objectives were reformulated to fit the rationale of the study. - In the sampling paragraph: few changes were made bymaking reformulation of the sentence and addition of an exclusion criteria which was diabetes type 1. This was already available but reformulated clearly in this section. - In Table 2, the range <5 years was amended to “1-5 years”. - Figures 1 and 2 were amended to include explanations about X and Y. Also, the responses to “No” were also added to the figures. - In paragraph 3.4, we made small typo edits and in Table 6, we made edits concerning decimals according to the reviewer 1 comments. - In discussion: a paragraph was added concerning the valuable insights of the current study for healthcare professionals. - In general, two references were added (13 and 14). According to reviewer 1 and 2: - No change was made in the title and abstract of the manuscript. - Changes are made in the “Introduction” where specific information about the rationale of the study, the global context of dietary use among patients with type 2 diabetes and the national use of dietary supplements were added. - In addition, the objectives were reformulated to fit the rationale of the study. - In the sampling paragraph: few changes were made bymaking reformulation of the sentence and addition of an exclusion criteria which was diabetes type 1. This was already available but reformulated clearly in this section. - In Table 2, the range <5 years was amended to “1-5 years”. - Figures 1 and 2 were amended to include explanations about X and Y. Also, the responses to “No” were also added to the figures. - In paragraph 3.4, we made small typo edits and in Table 6, we made edits concerning decimals according to the reviewer 1 comments. - In discussion: a paragraph was added concerning the valuable insights of the current study for healthcare professionals. - In general, two references were added (13 and 14). See the authors' detailed response to the review by Rabih Hallit See the authors' detailed response to the review by Abeer Salman Alzaben READ REVIEWER RESPONSES 1. Introduction Among the sustainable developmental goals (SDG), SDG 3.4 addresses Non-Communicable Diseases (NCDs) specifically, and world leaders committed to a one-third reduction in deaths between the ages 30 to 70 years from diabetes by the year 2030. Although the burden is worldwide, low- and middle-income countries (LMICs) are struggling with NCDs, especially Lebanon, with over three-quarters of all NCD deaths occurring in these countries. 1 In Lebanon, 91% of all deaths are attributed to NCDs, 2 and the initiatives, led by the Ministry of Public Health, to address the NCD burden failed to be implemented adequately. 3 – 5 This is due to the country’s political and economic challenges. 6 On the other hand, Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages 7 with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. 8 In Lebanon, there are no studies that investigate the prevalence of DS use and abuse among persons with T2DM or their knowledge, attitudes, and practices toward DS use. Our research group had already investigated DS use among children under 5 and their mothers (DS use: 64%), 9 among adults before versus during the COVID-19 pandemic (DS use: 73% versus 70%, respectively), 10 and among athletes (DS use: 74%). 11 On the other hand, in the United Sates, approximately 54% of individuals with diabetes used dietary supplements based on data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014. Older adults over 65 years had the highest usage at 62%, followed by those aged 40 to 64 years at 51%. Individuals aged 20 to 39 years had the lowest usage at 30%. Factors associated with higher dietary supplement consumption among individuals with diabetes included older age, female gender, non-Hispanic white ethnicity, higher education level, longer duration of diabetes, and presence of comorbidities such as cancer, chronic kidney disease, cardiovascular disease, and chronic obstructive pulmonary disease. 12 However, 6217 studies suggest limited clinical evidence supporting the use of dietary supplements for reducing or controlling diabetes. 13 At national level, conducting an assessment of knowledge, attitudes, and practices of dietary supplements among patients with Type II diabetes during the current Lebanese economic crisis is crucial for several reasons: 1) access to healthcare services and resources may be limited, leading individuals to seek alternative methods for managing their health conditions. 2) Understanding the knowledge, attitudes, and practices of dietary supplements among patients with Type II diabetes can help healthcare providers identify potential gaps in information and provide targeted education and support. 3) Individuals may experience heightened stress levels, changes in routine, and disruptions to their usual healthcare management. This can impact their dietary habits, medications use and supplement use, potentially leading to suboptimal health outcomes. By assessing the knowledge, attitudes, and practices of dietary supplements among patients with Type II diabetes, healthcare providers can tailor interventions to address specific needs and promote safe and effective supplement use during challenging times. Thus, the aims of the current study are: (1) to estimate the prevalence of DS use among persons with T2DM amid the escalating economic crisis in Lebanon; (2) to explore the knowledge, attitude, and practice (KAP) of DS use; and (3) to determine any significant association between socio-economic and socio-demographic factors and the use of DS modality. 2. Methods 2.1 Study design A cross-sectional study was conducted between August 1 and November 2022 across the 4 main governorates in Lebanon (Beirut, Mount Lebanon, Beqaa, and North Lebanon). This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. After the approval of the ethical committee at al Zahraa University Medical Center (#157/May 7, 2022), we approached the medical files of patients with T2DM to retrieve their phone numbers from many hospitals, outpatient departments, and private clinics in Lebanon. Patients signed a written consent form before being enrolled in the study. 2.2 Sample Convenience sampling was the method adopted to collect the information from the respondents. A total of 460 patients with T2DM were enrolled in this survey. The response rate was 100%. 2.2.1 Inclusion and exclusion criteria The criteria for inclusion of patients in the current study were: participants with T2DM who are older than 18 years and have given their informed consent to take part in the study. The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age. Moreover, all older patients with diabetes type 1 were also excluded. In addition, pregnant women with gestational diabetes, elderly people, and people with intellectual disabilities were excluded from this study. 2.3 Questionnaire Using a standardized questionnaire, a face-to-face interview between licensed dietitians and the patients was conducted. To ensure the validity of the data collection tool, the questionnaire was adapted from relevant literature in English, then translated by experts into Arabic and back-translated into English to check the translation. 14 The data was gathered using the administered questionnaire in Arabic. The questionnaire was made to find out the participants’ KAP on DS use as well as to identify the prevalence and most popular DS modalities in Lebanon. It was divided into five sections: (1) demographics, (2) clinical data about T2DM, (3) knowledge, (4) attitude, and (5) practice of DS therapies. All information about the patient’s demographics, including gender, age, marital status, level of education, and employment status, was recorded. Additionally, the time of the first time being diagnosed with T2DM, the type of T2DM therapy (insulin or oral medicines), the complications related to T2DM, and other co-morbid issues are clinical factors that were included in the study. In the knowledge section, we checked the knowledge of patients with T2DM with regard to DS efficacy and safety concerns. Moreover, in the attitude part, participants were asked about their attitudes toward the use of DS. Would they, for example, abide by their doctor’s recommendations to avoid using DS. Would they consult their physicians before using DS or not. In the practice section, we asked patients with T2DM if they had ever used DS for diabetes specifically. Participants who replied “yes” were then questioned about the type of DS used, who prescribed it, whether they were informed by their physician about it, whether they combined it with their T2DM medications, and whether they had ever used DS for a condition other than T2DM. 2.4 Data management and analysis The data was coded and checked for completeness and consistency. All responses from the questionnaire were entered into Microsoft Excel, and a quality check was performed; data cleaning. Then it was exported to SPSS. Statistical analysis was conducted using SPSS (IBM Corp, SPSS Statistics version 26) ( https://www.ibm.com/support/pages/spss-statistics-260-fix-pack-1 ). SPSS was used for data entry, coding, data management, and analysis. The results were described as frequencies and percentages for variables. The associations between both the demographic factors and the clinical data about T2DM with DS were determined using Pearson’s Chi-square test. A p value of ≤ 0.05 was considered significant. Odds ratio was considered as a measure of strength. Multivariate logistic regression was used to identify predictors of DS usage. 3. Results 3.1 Sociodemographic Characteristics of the study population Four hundred and sixty subjects participated in this study. The frequency distribution of their socio-demographic findings is presented in Table 1 . Most of the participants were aged 41-60 years (51.3 %), males (51.3 %), from North Lebanon (49.1%), married (60.2%), had a university degree (39.8%), unemployed (41.3%), and had no monthly income (35.4%) Table 1. Socio-demographic characteristics of the study participants (N=460). Socio-demographic variable N (%) Gender Male 236 (51.3) Female 224 (48.7) Marital status Single 113 (24.6) Married 277 (60.2) Divorced 37 (8.0) Widowed 33 (7.2) Age (years) 18-40 163 (51.3) 41-60 101 35.4) 61-65 61 (13.2) Education Illiterate 76 (16.5) Primary level 65 (14.1) Secondary level 64 (13.9) High school level 72 (15.7) University level 183 (39.5) Employment Don’t work 190 (41.3) Private job 108 (23.5) Part-time job 62 (13.5) Full-time job 100 (21.7) Income No income 163 (35.4) less than 1.5 million lira Lebanese 26 (5.7) between 1.5 and 3 million lira Lebanese 53 (11.5) greater than 3 million lira Lebanese 36 (7.8) less than 100 dollars 38 (8.3) between 100 and 300 dollars 66 (14.3) greater than 300 dollars 78 (17) Address Beirut and Mount Lebanon 76 (16.5) North Lebanon 352 (56.5) Beqaa 32 (5.8) 3.2 Participant’s medical characteristics The clinical data characteristics of the study participants with T2DM are shown in Table 2 . Most of the patients conducted their laboratory tests three months prior to the data collection (37%), and around 34% were newly diagnosed with T2DM. Furthermore, approximately 32% of the study participants developed diabetic complications such as neuropathy (5.7%), nephropathy (5.7%), diabetic foot syndrome (7.2%), and retinal disease (13.5%), which was the most common. Most of the study participants had a family history of T2DM (88.7%), most of them inherited T2DM from their fathers (31.3%). As for medical treatment, the vast majority of patients (72%) were on oral anti-diabetic medications, and most of them had other medical comorbidities such as coronary artery disease (21.3%), osteoporosis (9.3%), kidney disease (8.7%), and hypertension (23.7%). Table 2. Medical characteristics of the study participants. Clinical data N (%) Length of T2DM Newly diagnosed 154 (33.5) 1–5 years 138 (3) Between 5–10 years 88 (19.1) Greater than 10 years 80 (17.4) Monitoring laboratory test value 3 months prior to data collection 170 (37) 6 months prior to data collection 110 (23.9) One year prior to data collection 127 (27.6) More than one year prior to data collection 53 (11.5) Medications Oral pills 333 (72.4) Insulin 75 (16.3) Combinations 52 (11.3) T2DM complications None 313 (68) Neuropathy 26 (5.7) Renal disease 26 (5.7) Retinopathy 62 (13.5) Foot disease 33 (7.2) Family history of T2DM No 52 (11.3) Father 143 (31.3) Mother 56 (12.2) Sisters and brothers 37 (8) Relatives 44 (9.6) More than one choice 128 (27.8) Co-morbidities Coronary disorders 98 (21.3) Osteoporosis 43 (9.3) Hypertension 109 (23.7) Kidney disorders 40 (8.7) Anemia 84 (18.3) Others a 29 (12.7) a Retinal eye disease, nasal allergy, ear disease, liver disease, foot disease, polycystic ovary syndrome, thyroid, asthma, gastrointestinal disorders, and thrombocytopenia. 3.3 Knowledge, attitudes, and practices concerning the dietary supplements use 3.3.1 Knowledge Figure 1 shows the participants’ knowledge towards the use of DS among persons with T2DM during the economic crisis. It appears that most of them (85.9%) had heard about DS, more than half of the sample (63%) knew that DS had efficacity, and 67% believed that DS are safe as shown in Figure 1 . Figure 1. Participants’ responses to the knowledge questions concerning DS use. X axis refers to the percentage of patients responding the questions raised in Y axis. DS, Dietary supplements. 3.3.2 Attitudes The participants’ attitudes regarding DS use are presented in Figure 2 . It was shown that 81% of patients would first discuss DS use with their physician and that the majority (85.7%) would not use it if their physicians didn’t recommend it. On the other hand, more than half of participants (57.6%) suggested the same DS to a family member as shown in Figure 2 . Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. “Strongly agree” and “agree” responses were combined to show the total percentage of “good attitude,” “neutral” for “not aware”, while “disagree” and “strongly disagree” were also combined to show the total percentage for “poor attitude.” One-third of the participants agreed that nutritional supplements can control the management of diabetes and prevent further complications such as retinal disease, foot disease, kidney disease, and nerve damage. On the contrary, only 34% of patients disagreed that nutritional supplements are a suitable substitute for a healthy and balanced diet in the treatment of diabetes. Furthermore, more than 44% disagreed that nutritional supplements are as effective as medication in modifying blood sugar levels in diabetic patients. Figure 2. Participants’ responses to the attitude questions concerning DS use. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. DS, Dietary supplements. Table 3. Frequency of responses to the attitudes-related questions that are based on a Likert scale scoring system. Attitude Agree Strongly agree Neutral Disagree Strngly disagree N % n % n % n % n % Are nutritional supplements or some of them necessary to control diabetes? 112 24.3 44 9.6 218 47.4 50 10.9 36 7.8 Do you think that nutritional supplements or some of them are a suitable alternative to a healthy and balanced diet for diabetics? 88 19.1 24 5.2 192 41.7 92 20.0 64 13.9 Do you think that DS prevents diabetes complications? 106 23.0 37 8.0 214 46.5 65 14.1 38 8.3 In your opinion, do nutritional supplements have the same effectiveness as medications in modifying the blood sugar level in diabetic patients? 61 13.3 29 6.3 168 36.5 89 19.3 113 24.6 3.3.3 Practices Among people with T2DM, the estimated prevalence of DS use during the escalating crisis was 41.1% as shown in Figure 3 . It appears that more than half the participants used previously DS to prevent other medical complications and combine DS with their diabetes medications. This use was always controlled by their physicians rather than using it on their own as shown in Figure 4 . Multivitamins (27.6%) and vitamin C (22.4%) were the most DS used daily ( Table 4 ). Furthermore, per monthly and/or weekly use, vitamin D (11.3%), ginger supplements (14.3%) and green tea supplements (7.4%) were the most recorded DS ( Table 4 ). According to Table 5 , around 41.1% of the participants complain about hypoglycemia and used DS to control their blood sugar levels (56.4%), while the rest used it to improve their health (35.5%) and control their diet (2.2%). What’s more, it has been demonstrated that 65% of the participants always read the DS label before ingesting it and 67.6% will use always continue using the DS ( Table 5 ). Figure 3. Prevalence responses of DS use and practices among patients with T2DM. DS, Dietary supplements; T2DM, type 2 diabetes mellitus. Figure 4. Sources of information on DS for patients with T2DM. DS, Dietary supplements; T2DM, type 2 diabetes mellitus. Table 4. Frequency of consumption of dietary supplements by patients with T2DM. DS practices Everyday N (%) 1/week N (%) 1/month N (%) Several times/week N (%) Never N (%) Multivitamins 127 (27.6) 25 (5.4) 16 (3.5) 17 (3.7) 275 (59.8) Vitamin A 20 (4.3) 15 (3.3) 29 (6.3) 13 (2.8) 383 (83.3) Vitamin C 103 (22.4) 32 (7) 33 (7.2) 30 (6.5) 262 (57) Vitamin D 99 (21.5) 52 (11.3) 36 (7.8) 30 (6.5) 243 (52.8) Vitamin E 10 (2.2) 17 (3.7) 35 (7.6) 10 (2.2) 388 (84.3) Vitamin B1 13 (2.8) 17 (3.7) 21 (4.6) 14 (3) 395 (85.9) Vitamin B2 11 (2.4) 10 (2.2) 23 (5) 15 (3.3) 401 (87.2) Vitamin B3 10 (2.2) 14 (3) 26 (5.7) 11 (2.4) 399 (86.7) Vitamin B6 38 (8.3) 19 (4.1) 26 (5.7) 18 (3.9) 359 (78) Vitamin B12 48 (10.4) 22 (4.8) 31 (6.7) 13 (2.8) 346 (75.2) Folic acid 23 (5) 11 (2.4) 27 (5.9) 12 (2.6) 387 (84.1) Calcium 80 (17.4) 30 (6.5) 23 (5) 19 (4.1) 308 (67) Chromium 11 (2.4) 18 (3.9) 29 (6.3) 7 (1.5) 395 (85.9) Iron 83(18) 14 (3) 31 (6.7) 16 (3.5) 316 (68.7) Magnesium 81 (17.6) 21 (4.6) 28 (6.1) 20 (4.3) 310 (67.4) Zinc 37 (8) 15 (3.3) 29 (6.3) 13 (2.8) 366 (79.6) Iodine 11 (2.4) 17 (3.7) 27 (5.9) 10 (2.2) 395 (85.9) Cumin 43 (9.3) 31 (6.7) 37 (8) 25 (5.4) 324 (70.4) Aloe vera 22 (4.8) 24 (5.2) 49 (10.7) 13 (2.8) 352 (76.5) Ginger 64 (13.9) 34 (7.4) 66 (14.3) 28 (6.1) 268 (58.3) Green tea 79 (17.2) 45 (9.8) 46 (10) 34 (7.4) 256 (55.7) Table 5. Answers to questions on using dietary supplements, symptoms, labels, and continuous use. Questions N (%) The reason to use DS To improve sugar level 259 (56.4) To improve health 163 (35.5) To improve the diet 10 (2.2) Don’t use 27 (5.9) Symptoms due to DS use None 258 (56.1) Hypoglycemia 189 (41.1) Tachycardia 1 (0.2) Abdominal pain 5 (1.1) Loss of appetite 1 (0.2) Anxious 4 (0.9) Headache 2 (0.4) Do you read the label of DS before using it Always 298 (64.8) Sometimes 131 (28.5) Scarcely 8 (1.7) Never 23 (5) Will you use nutritional supplements again? Yes 311 (67.6) No 149 (32.4) 3.4 Determinants of DS use using binary logistic analysis among study participants Based on the bivariate analysis, we attempted to determine the extent of the contribution of the variables of interest to the probability of dietary supplements use among patients with T2DM using the logistic regression analysis. Table 6 shows that the gender, age, residency, marital status, monthly income, being employed, being on diet, having other comorbidities, length of diabetes disease, family history, knowledge about the efficacity and safety of DS and the source of information regarding DS were not considered as predictors for the use of DS among T2MD patients. On the other hand, the level of education can mediate the use of DS. For instance, those who are university graduates ranked first among DS consumers compared to those who are uneducated or above [OR=3.9, CI=1.5-10, p=0.003). In addition, patients with T2DM who monitor less their blood sugars have a 5 times higher odd to buy more DS compared to their counterparts (OR=4.3, CI=1.78-10.8; p=0.001). Furthermore, patients who never read the label were more prone to buy DS compared to patients who always read the label [OR=28.2, CI=3.5-225, p=0.002]. Table 6. Determinants of DS use among patients with T2DM. Variables DS use N % P value OR Lower Upper Gender 0.09 Female 224 48.7 Male 236 51.3 0.63 0.36 1.08 Age 0.12 ≤40 163 35.4 41-49 68 14.8 0.04 0.46 0.21 0.99 50-59 142 30.9 0.79 0.91 0.47 1.77 ≥ 60 87 18.9 0.17 0.55 0.24 1.28 Address 0.7 Beirut and Mount Lebanon 76 16.5 North Lebanon 352 76.5 0.33 1.35 0.73 2.50 Baalbek/Hermel and Beqaa 27 5.9 0.49 1.49 0.47 4.70 South Lebanon 5 1.1 0.40 2.95 0.22 38.55 Education 0.024 Uneducated 76 16.5 Primary level 65 14.1 0.027 3.17 1.14 8.86 Secondary level 64 13.9 0.46 1.43 0.55 3.73 High school level 72 15.7 0.16 1.97 0.75 5.16 University level 183 39.8 0.003 3.98 1.58 10.01 Marital status 0.39 Single 113 24.6 Married 277 60.2 0.10 1.67 0.89 3.14 Divorced 37 8.0 0.56 1.32 0.50 3.49 Widower 33 7.2 0.19 1.97 0.70 5.55 Employment 0.25 Don’t work 190 41.3 Have a job 270 58.7 1.61 0.71 3.65 Income 0.209 No income 163 35.4 Less than 100 $ 153 33.3 0.139 0.53 0.23 1.22 Between 100$ and 300$ 66 14.3 0.717 0.83 0.31 2.23 Greater than 300 $ 78 17 0.097 0.42 0.15 1.16 Other comorbidities 0.679 No 224 48.7 Yes 236 51.3 0.90 0.55 1.46 Adherence to diet 0.622 No 50 10.9 Yes 164 35.7 0.765 1.17 0.40 3.38 Sometimes 246 53.5 0.711 0.82 0.29 2.30 Duration of having diabetes 0.802 Newly diagnosed 154 33.5 Less than 5 years 138 30.0 0.93 0.97 0.52 1.79 Between 5 and 15 years 127 27.6 0.47 0.78 0.39 1.53 Greater than 15 years 41 8.9 0.44 0.68 0.25 1.80 Monitoring tests Laboratory values 0.008* Since 3 months 170 37.0 Since 6 months 110 23.9 0.76 0.91 0.49 1.68 Since 1 year 127 27.6 0.52 1.20 0.67 2.15 More than 1 year 53 11.5 0.001 4.39 1.78 10.82 Family history 0.879 No 52 11.3 Yes 408 88.7 0.94 0.43 2.0 Heard DS 0.88 Yes 395 85.9 No 65 14.1 1.06 0.45 2.5 Safe DS 0.12 Yes 310 67.4 No 16 3.5 0.17 3.99 0.55 28.9 Don’t know 134 29.1 0.09 1.86 0.90 3.8 Effective DS 0.41 Yes 290 63.0 No 18 3.9 0.37 0.48 0.10 2.3 Don’t know 152 33.0 0.44 1.31 0.65 2.6 Source of information 0.98 Medical and paramedical 224 48.7 Other 236 51.3 0.99 0.61 1.6 Reading label 0.000 Always 298 64.8 Sometimes 131 28.5 0.000 6.87 3.75 12.5 Scarcely 8 1.7 0.056 8.82 0.94 82.4 Never 23 5.0 0.002 28.26 3.53 225.8 4. Discussion To the best of our knowledge, this is the first study that investigates the prevalence, and correlates of DS use among patients with T2DM during the economic crisis and drug shortage time in Lebanon. Almost 4 out of 10 patients with T2DM in our study were found to be using and abusing DS. Compared to the Unites states of America (USA), it was shown that 6 out of 10 Americans with T2DM use DS. 15 The prevalence reported in our study was higher than that reported in Saudi Arabia (17.6%), 16 Australia (24%), 17 and Thailand (5.3%) 18 but lower than the prevalence observed in Canada (44%), 19 and in 3 studies from the United States of America (USA) (62.1%; 67%; 58%). 20 – 22 The most common DS used daily in the current study were multivitamins (27.6%), vitamin C (22.4%), followed by vitamin D (21.5%), iron (18%), and calcium (17.4%). These findings came hand in hand with the data reported in a Canadian study 19 (27.5% multivitamins, 18.9% vitamin E, 18.7% vitamin C, and 16% calcium), but it contradicts the results reported in Clifford et al., where in Australia vitamin C (18%) ranked first followed by garlic (17%), omega 3 (14%), vitamin E (13%) and multivitamins (12%). 17 According to the literature, the use of DS for diabetes management has always been reviewed from a pharmacy standpoint and from that of complementary and alternative medicine. 23 However, as supplement use continues to grow in Lebanon, 9 – 11 it is important for healthcare professionals to understand the evidence behind prescribing supplements and their potential role as part of medical care especially during the unstable conditions. For instance, according to the literature review, meta-analyses assessing the impact of vitamin C supplementation on diabetes-related outcomes assumed an improvement of fasting blood glucose only without any improvement in HbA1c in patients with T2DM. 24 – 26 In addition, three meta-analyses that examined folate or folic acid supplementation had conflicting findings. 27 – 29 As for B12 supplementation, many studies showed that individuals taking Metformin suffer from depleted serum B12 levels, and human studies on both B6 and biotin were extremely limited, with a lack of narrative reviews on both vitamins’ impact on T2DM patients. 30 On the other hand, a meta-analysis that assessed the niacin supplementation showed an increased risk of T2DM onset following supplementation. 31 As for vitamin D, a review conducted by Li et al. showed that most studies in patients with T2DM used vitamin D at 2000 IU/day, which may improve glycemic control and a dose of 4000 IU/day may be elicited to provide positive effects on HbA1c, HOMA-IR, and the fasting plasma glucose. 32 The DS used by our study population was prescribed mainly by their physicians (70.2%). However, in the Arabian Gulf states, patients with T2DM did not reveal, discuss, or even seek medical advice from a physician, which differed from our findings, where participants relied heavily on physicians for DS advice. For instance, out of six studies conducted in the Gulf Club Countries (GCC), most DS users did not tell their physicians about the use of DS. 16 , 33 – 37 Similarly, in Nigeria and the USA where the majority of DS among patients with T2DM were not being taken based on a recommendation from a health provider. 15 , 38 More than half of the participants in our study were satisfied with their DS use and intended to use it again (67.6%). Unlike Saudi Arabian participants with T2DM, where only 6.7% of respondents said they would use DS again, and 55.7% regretted its use. 14 In our study, 85% of the participants had heard of DS, some of them (67.4%) believed DS were safe, and more than half (63%) knew that DS are effective where 33.9% agreed that DS are necessary to control diabetes and 31% strongly agreed that DS prevent diabetic complications. These findings align with the data reported in an updated literature review that showed that patients usually expressed the attitude that DS may not help much but will not hurt. 39 Additionally, our participants’ main reason for utilizing DS in this study was to lower their blood sugar level (56.1%), followed by improving overall health (35.5%). Thus, a responsible healthcare approach is much needed for the patients to receive evidence-based DS information about efficacy, effectiveness, adverse effects, and possible interactions. A slight majority (57.2%) of participants supported the use of DS in conjunction with their medical treatment for T2DM. This finding aligns with the result observed in a Saudi Arabian and Nigerian study where 90% and 67% of the patients with T2DM preferred combining DS with their conventional therapies, respectively. 16 , 38 In a qualitative study in Pakistan, the principal motivator of DS use was the desire to cure T2DM, where 41% preferred combining DS and T2DM. 40 In our study, the level of education, the frequency of monitoring blood sugars, and reading labels can mediate the use of DS. On contrary, the predictors of DS use in Saudi Arabia were age above 51 years, unemployment, and the participants’ knowledge about the effectiveness of complementary and alternative medicine (CAM) products. 16 Moreover, in Thailand, female gender, age 40-69 years, and diabetes duration of less than 10 years were significant correlators of DS use. 41 A Chinese study found that DS use among people with T2DM was associated with a history of previous DS use for other conditions, a positive attitude towards DS, efficacy of DS, and a longer duration of diabetes. 42 Moreover, a study from Malaysia found that females were 1.8 times more likely to use DS than males. 43 Furthermore, a study from Bahrain showed that females DS users were more likely to be dominating, and those who have had diabetes for a longer time and have T2DM complications were the top users. 44 Another study from Saudi Arabia showed that the most common users of DS practices were older females, housewives, and illiterates. 45 Clinical implications of the current study The current study can provide valuable insights for healthcare professionals to optimize patient care and support informed decision-making regarding supplement use in several ways: 1. Improved patient education: Understanding the knowledge, attitudes, and practices of dietary supplement use among individuals with diabetes can help healthcare professionals tailor their patient education efforts. They can provide more targeted information on the benefits and risks of specific supplements, as well as guidance on safe and effective supplement use. 2. Enhanced treatment planning: Healthcare professionals can use the findings from the study to inform their treatment planning for individuals with diabetes. They can incorporate evidence-based recommendations on dietary supplements that may complement conventional treatment approaches and support overall health outcomes. 3. Identification of gaps in care: The study can help healthcare professionals identify any gaps in care related to dietary supplement use among individuals with diabetes. This information can guide the development of interventions or resources to address these gaps and improve patient outcomes. 4. Promotion of evidence-based practice: By understanding the knowledge, attitudes, and practices of dietary supplement use among individuals with diabetes, healthcare professionals can promote evidence-based practice and discourage the use of potentially harmful or ineffective supplements. This can lead to better health outcomes for individuals with diabetes. Limits and strengths This study presents some limitations. First, it lacks the impact of DS on T2DM compared to conventional therapy. Second, a self-reported questionnaire was used for most of the reported measures. Thus, bias may be present due to inaccurate self-reporting and memory in some questions. Third, this study was of cross-sectional survey; therefore, only associations can be determined and not causations. Notably, the strength of this study is that it is the first study that has been carried out in Lebanon which brought up the topic of knowledge, attitudes, and practices to DS use among patients with T2DM. 5. Conclusion This study estimated the prevalence of DS use and abuse among patients with T2DM during the time of medicine shortage and economic crisis. Public health experts should encourage healthy discussions with their patients to comprehend their views regarding DS use. In addition, clinicians and researchers should collaborate to initiate safety and efficacy trials on common DS used for diabetes. Accordingly, relevant institutions whether governmental and non-governmental organizations, are strongly asked to design awareness programs that will be addressed to target groups and implemented by a specialized team in which social workers and health promoters play an important role by developing materials which fit all the perception of all categories that were shown by the study, and especially suitable to those who are illiterate, and who cannot read labels. The presence of evidence-based studies in the form of randomized controlled trials will help both patients and clinicians regarding the use of a DS product. Ethics and consent The study was approved by the ethical committee of al Zahraa University Medical Center (#157/May 7, 2022). Written informed consent was obtained from all subjects involved in the study. Written informed consent was obtained also from the patient(s) to publish this paper. Authors’ contributions MA, RM and MH conceived the idea, designed the study, helped in collecting the data, analyzed the data, drafted and reviewed the manuscript. SD helped in collecting the data, reviewed and edited the manuscript. NA and MS collected and analyzed the data. All authors read and approved the final manuscript. Data availability Underlying data Open Science Framework: Dietary Supplement and Diabetes type II. https://doi.org/10.17605/OSF.IO/ZVNJD . 46 This project contains the following underlying data - Dietary supplement and diabetes spss.sav - STROBE checklist Data are available under the terms of the Creative Commons Zero “No rights reserved” data waiver (CC0 1.0 Public domain dedication). References 1. Global Week for Action on NCDs: (accessed on 13 April 2023). Reference Source 2. WHO EMRO: Health of Refugees and Migrants 2018. (accessed on 13 April 2023). Reference Source 3. Non-Communicable Diseases Prevention and Control Plan (NCD-PCP) Lebanon 2016-2020. Accessed 13 Apr 2023. Reference Source 4. World health Organization: PRIMARY HEALTH CARE SYSTEMS (PRIMASYS) Comprehensive case study from Lebanon 2017. Google Search. Accessed 13 Apr 2023. Reference Source 5. Doocy S, Lyles E, Hanquart B, et al. : Prevalence, care-seeking, and health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon. Confl. Heal. 2016; 10 : 1–17. 6. Zablith N, Diaconu K, Naja F, et al. : Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting. Confl. Heal. 2021; 15 : 1–13. 7. Das M: Lebanon faces critical shortage of drugs. Lancet Oncol. 2021; 22 : 1063. PubMed Abstract | Publisher Full Text | Free Full Text 8. Nyenwe EA, Jerkins TW, Umpierrez GE, et al. : Management of type 2 diabetes: evolving strategies for the treatment of patients with type 2 diabetes. Metabolism. 2011; 60 : 1–23. PubMed Abstract | Publisher Full Text | Free Full Text 9. Mohsen H, Ibrahim C, Bookari K, et al. : Prevalence of Essential Nutrient Supplement Use and Assessment of the Knowledge and Attitudes of Lebanese Mothers towards Dietary Supplement Practices in Maternal, Infancy and Preschool Ages: Findings of a National Representative Cross-Sectional Study. Foods. 2022; 11 : 3005. PubMed Abstract | Publisher Full Text | Free Full Text 10. Mohsen H, Yazbeck N, Al-Jawaldeh A, et al. : Knowledge, attitudes, and practices related to dietary supplementation, before and during the COVID-19 pandemic: Findings from a cross-sectional survey in the Lebanese population. Int. J. Environ. Res. Public Health. 2021; 18 : 8856. PubMed Abstract | Publisher Full Text | Free Full Text 11. Sadek Z, Mohsen H, Yazbek S, et al. : Dietary Supplements Use among Athletes in Lebanon: Knowledge, Attitudes, Practices, and Correlates. Foods. 2022; 11 : 1521. PubMed Abstract | Publisher Full Text | Free Full Text 12. Li J, Li X, Gathirua-Mwangi W, et al. : Prevalence and trends in dietary supplement use among US adults with diabetes: the National Health and Nutrition Examination Surveys, 1999-2014. BMJ Open Diabetes Res. Care. 2020 Jan; 8 (1): e000925. PubMed Abstract | Publisher Full Text | Free Full Text 13. Hannon BA, Fairfield WD, Adams B, et al. : Use and abuse of dietary supplements in persons with diabetes. Nutr Diabetes. 2020 Apr 27; 10 (1): 14. PubMed Abstract | Publisher Full Text | Free Full Text 14. Rovira M-A, Grau M, Castañer O, et al. : Dietary supplement use and health-related behaviors in a Mediterranean population. J. Nutr. Educ. Behav. 2013; 45 : 386–391. PubMed Abstract | Publisher Full Text 15. Wilson PB: Population-representative analysis of dietary supplementation among Americans with diabetes mellitus. J. Diabetes. 2019; 11 : 115–121. PubMed Abstract | Publisher Full Text 16. Al-Eidi S, Tayel S, Al-Slail F, et al. : Knowledge, attitude and practice of patients with type 2 diabetes mellitus towards complementary and alternative medicine. J. Integr. Med. 2016; 14 : 187–196. PubMed Abstract | Publisher Full Text 17. Clifford RM, Batty KT, Davis W, et al. : Prevalence and predictors of complementary medicine usage in diabetes: Fremantle diabetes study. J. Pharm. Pract. Res. 2003; 33 : 260–264. Publisher Full Text 18. Sripa S: Usage of and cost of complementary/alternative medicine in diabetic patients. J. Med. Assoc. Thail. 2005; 88 : 1630–1637. 19. Ryan EA, Pick ME, Marceau C: Use of alternative medicines in diabetes mellitus. Diabet. Med. 2001; 18 : 242–245. Publisher Full Text 20. Arcury TA, Bell RA, Snively BM, et al. : Complementary and alternative medicine use as health self-management: rural older adults with diabetes. J. Gerontol. Ser. B Psychol. Sci. Soc. Sci. 2006; 61 : S62–S70. PubMed Abstract | Publisher Full Text | Free Full Text 21. Garrow D, Egede LE: Association between complementary and alternative medicine use, preventive care practices, and use of conventional medical services among adults with diabetes. Diabetes Care. 2006; 29 : 15–19. PubMed Abstract | Publisher Full Text 22. Li J, Li X, Gathirua-Mwangi W, et al. : Prevalence and trends in dietary supplement use among US adults with diabetes: the National Health and Nutrition Examination Surveys, 1999–2014. BMJ Open Diabetes Research and Care. 2020; 8 : e000925. PubMed Abstract | Publisher Full Text | Free Full Text 23. Yilmaz Z, Piracha F, Anderson L, et al. : Supplements for diabetes mellitus: a review of the literature. J. Pharm. Pract. 2017; 30 : 631–638. Publisher Full Text 24. Ashor AW, Werner AD, Lara J, et al. : Effects of vitamin C supplementation on glycaemic control: a systematic review and meta-analysis of randomised controlled trials. Eur. J. Clin. Nutr. 2017; 71 : 1371–1380. PubMed Abstract | Publisher Full Text 25. de Paula TP , Kramer CK, Viana LV, et al. : Effects of individual micronutrients on blood pressure in patients with type 2 diabetes: a systematic review and meta-analysis of randomized clinical trials. Sci. Rep. 2017; 7 : 40751. PubMed Abstract | Publisher Full Text | Free Full Text 26. Khodaeian M, Tabatabaei-Malazy O, Qorbani M, et al. : Effect of vitamins C and E on insulin resistance in diabetes: a meta-analysis study. Eur. J. Clin. Investig. 2015; 45 : 1161–1174. Publisher Full Text 27. Akbari M, Tabrizi R, Lankarani KB, et al. : The effects of folate supplementation on diabetes biomarkers among patients with metabolic diseases: a systematic review and meta-analysis of randomized controlled trials. Horm. Metab. Res. 2018; 50 : 93–105. PubMed Abstract | Publisher Full Text 28. Sudchada P, Saokaew S, Sridetch S, et al. : Effect of folic acid supplementation on plasma total homocysteine levels and glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 2012; 98 : 151–158. PubMed Abstract | Publisher Full Text 29. Zhao JV, Schooling CM, Zhao JX: The effects of folate supplementation on glucose metabolism and risk of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Ann. Epidemiol. 2018; 28 : 249–257.e1. PubMed Abstract | Publisher Full Text 30. Yan MK-W, Khalil H: Vitamin supplements in type 2 diabetes mellitus management: A review. Diabetes Metab. Syndr. 2017; 11 : S589–S595. Publisher Full Text 31. Verdoia M, Schaffer A, Suryapranata H, et al. : Effects of HDL-modifiers on cardiovascular outcomes: a meta-analysis of randomized trials. Nutr. Metab. Cardiovasc. Dis. 2015; 25 : 9–23. PubMed Abstract | Publisher Full Text 32. Li X, Liu Y, Zheng Y, et al. : The effect of vitamin D supplementation on glycemic control in type 2 diabetes patients: a systematic review and meta-analysis. Nutrients. 2018; 10 : 375. PubMed Abstract | Publisher Full Text | Free Full Text 33. Al-Rowais NA: Herbal medicine in the treatment of diabetes mellitus. Saudi Med. J. 2002; 23 : 1327–1331. PubMed Abstract 34. Al Saeedi M, El Zubier AG, Bahnassi AA, et al. : Patterns of belief and use of traditional remedies by diabetic patients in Mecca, Saudi Arabia. East Mediterr. Health J. 2003; 9 (1-2): 99–107. PubMed Abstract | Publisher Full Text 35. Al-Garni AM, Al-Raddadi RM, Al-Amri TA: Patterns and determinants of complementary and alternative medicine use among type 2 diabetic patients in a diabetic center in Saudi Arabia: herbal alternative use in type 2 diabetes. J. Fundam. Appl .Sci. 2017; 9 : 1738–1748. 36. Kamel FO, Magadmi RM, Hagras MM, et al. : Knowledge, attitude, and beliefs toward traditional herbal medicine use among diabetics in Jeddah Saudi Arabia. Complement. Ther. Clin. Pract. 2017; 29 : 207–212. PubMed Abstract | Publisher Full Text 37. Bakhotmah BA, Alzahrani HA: Self-reported use of complementary and alternative medicine (CAM) products in topical treatment of diabetic foot disorders by diabetic patients in Jeddah, Western Saudi Arabia. BMC. Res. Notes. 2010; 3 : 1–8. 38. Amaeze OU, Aderemi-Williams RI, Ayo-Vaughan MA, et al. : Herbal medicine use among type 2 diabetes mellitus patients in Nigeria: understanding the magnitude and predictors of use. Int. J. Clin. Pharm. 2018; 40 : 580–588. PubMed Abstract | Publisher Full Text 39. Chang H, Wallis M, Tiralongo E: Use of complementary and alternative medicine among people living with diabetes: literature review. J. Adv. Nurs. 2007; 58 : 307–319. PubMed Abstract | Publisher Full Text 40. Bukhsh A, Gan SH, Goh B-H, et al. : Complementary and alternative medicine practices among type 2 diabetes patients in Pakistan: a qualitative insight. Eur. J. Integr. Med. 2018; 23 : 43–49. Publisher Full Text 41. Wanchai A, Phrompayak D: Use of complementary and alternative medicine among Thai patients with type 2 diabetes mellitus. J. Integr. Med. 2016; 14 : 297–305. PubMed Abstract | Publisher Full Text 42. Chang H-YA, Wallis M, Tiralongo E: Predictors of complementary and alternative medicine use by people with type 2 diabetes. J. Adv. Nurs. 2012; 68 : 1256–1266. PubMed Abstract | Publisher Full Text 43. Ching SM, Zakaria ZA, Paimin F, et al. : Complementary alternative medicine use among patients with type 2 diabetes mellitus in the primary care setting: a cross-sectional study in Malaysia. BMC Complement. Altern. Med. 2013; 13 : 1–7. 44. Khalaf AJ, Whitford DL: The use of complementary and alternative medicine by patients with diabetes mellitus in Bahrain: a cross-sectional study. BMC Complement. Altern. Med. 2010; 10 : 1–5. 45. Elolemy AT, AlBedah AM: Public knowledge, attitude and practice of complementary and alternative medicine in Riyadh region, Saudi Arabia. Oman Med. J. 2012; 27 : 20–26. PubMed Abstract | Publisher Full Text | Free Full Text 46. Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text Comments on this article Comments (1) Version 2 VERSION 2 PUBLISHED 26 Jul 2024 Revised Comment ADD YOUR COMMENT Version 1 VERSION 1 PUBLISHED 01 May 2024 Discussion is closed on this version, please comment on the latest version above. Author Response 26 Jun 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jun 2024 Author Response Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order ... Continue reading Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Competing Interests: No competing interests Close Report a concern Discussion is closed on this version, please comment on the latest version above. Author details Author details 1 Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 2 Faculty of Public Health, Section 3, Lebanese University, Tripoli, Lebanon 3 School of Social Sciences and Humanities, Program of Social Work, Doha Institute for Graduate Studies, Doha, Doha, Qatar 4 Food Science Unit, National Council for Scientific Research Lebanon (CNRS-L), Beirut, Lebanon Maher Abdallah Roles: Conceptualization, Formal Analysis, Methodology, Project Administration, Writing – Original Draft Preparation Sahar Dandachy Roles: Data Curation, Methodology, Writing – Review & Editing Nour Ahmad Roles: Methodology, Writing – Review & Editing Marwa Sleiman Roles: Methodology, Writing – Review & Editing Rania Mansour Roles: Investigation, Supervision, Writing – Review & Editing Maha Hoteit Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Resources, Supervision, Validation, Writing – Original Draft Preparation Competing interests No competing interests were disclosed. Grant information Open access funding provided by the Qatar National Library. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Article Versions (2) version 2 Revised Published: 26 Jul 2024, 13:432 https://doi.org/10.12688/f1000research.146998.2 version 1 Published: 01 May 2024, 13:432 https://doi.org/10.12688/f1000research.146998.1 Copyright © 2024 Abdallah M et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Abdallah M, Dandachy S, Ahmad N et al. Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.12688/f1000research.146998.2 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 26 Jul 2024 Revised Views 0 Cite How to cite this report: Alzaben AS. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307414 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307414 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Aug 2024 Abeer Salman Alzaben , Department of Health Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh Province, Saudi Arabia Approved VIEWS 0 https://doi.org/10.5256/f1000research.168897.r307414 Thank you for ... Continue reading READ ALL Thank you for making the required changes. Competing Interests: No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Alzaben AS. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307414 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307414 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Hallit R. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307415 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307415 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 27 Jul 2024 Rabih Hallit , Holy Spirit University of Kaslik, Jounieh, Lebanon Approved VIEWS 0 https://doi.org/10.5256/f1000research.168897.r307415 Dear authors, thank you for ... Continue reading READ ALL Dear authors, thank you for the changes made. No more comments from my side. Good luck! Competing Interests: No competing interests were disclosed. Reviewer Expertise: Infectious disease and internal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hallit R. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307415 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307415 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Version 1 VERSION 1 PUBLISHED 01 May 2024 Views 0 Cite How to cite this report: Alzaben AS. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275467 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275467 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Jun 2024 Abeer Salman Alzaben , Department of Health Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh Province, Saudi Arabia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.161131.r275467 Thank you for providing me the opportunity to review the manuscript. below some of my comments to make the manuscript more clear: Introduction : · Introduction is too short and lack of the rational. If ... Continue reading READ ALL Thank you for providing me the opportunity to review the manuscript. below some of my comments to make the manuscript more clear: Introduction : · Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? . may be need some information about % Dm in Lebanon or DS use ? · Does the objective to assess DS among all individuals with DM or only Type 2? Methods : · Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” Inclusion/ exclusion criteria, · “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? · What about other disease such as Celiac or food allergies. Are those excluded? · Regarding the KSP. More information is needed about scoring. does the questions with one option · Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. Results : · Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? · Be consistent with decimals · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. · How many participants have never used DS? · Table 6 in education, I did not see the illiterate group in the Determinants. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Alzaben AS. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275467 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275467 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Jul 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jul 2024 Author Response Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank ... Continue reading Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank you for this comment. The introduction was amended based on your comments. We are worried about DS use because Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. This was mentioned in lines 56-60. -May be need some information about % Dm in Lebanon or DS use ? There is no information concerning DS use among patients with diabetes type 2 in Lebanon but we already mentioned that we already assessed DS use among: children under 5 and their mothers, adults and athletes. This was added in lines 62-64. - Does the objective to assess DS among all individuals with DM or only Type 2? This is mentioned in rationale, objectives and methodology: patients with type 2 diabetes only. -Methods : - Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” The whole paragraph was amended. Inclusion/ exclusion criteria, “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? Yes these patients were also excluded. This was amended in the same paragraph. What about other diseases such as Celiac or food allergies. Are those excluded? This was not mentioned as an exclusion criterion. However, none of our patients were having these diseases because we were collecting the medical history of the patients. All patients who were excluded were having abnormal levels of glycemia, confirmed having type 2 diabetes and not diabetes type 1. Regarding the KSP. More information is needed about scoring. does the questions with one option. As mentioned in the “Methodology” section, the questions were having multiple responses for instance the Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. There was no single score, but we were showing the response of the patients. We are planning in future studies to validate this score. Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. We already mention in “Methodology” that we are assessing the current use of the DS by the patients. The answers of these questions are mentioned in Table 4 showing the frequency of the current use by the patients (per day, week, month…). The use of pills was most considered compared to the quantity. Based on that the frequency was our main objective. Results : Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? This was presented in Table 6 which shows that people who are educated had an 1.4-3.9 higher odd of using DS compared to those who are illiterate. · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? Newly diagnosed are those who were diagnosed in the same year. The other sub-groups are defined as 1-5 years. This was amended in the manuscript and the tables. · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? All patients with DT1 were excluded. And yes only patients with type 2 DM were included in the study. · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? 86% of participants know and heard about DS and 14% don’t know about it. We only highlighted the answer “Yes” and “Don’t Know”. However, we amended Figure 1. Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? Based on the study source of the questionnaire, these questions were related to knowledge questions. · Be consistent with decimals This was amended in the manuscript. · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. This sentence was added to the Figures in the manuscript to make it more clearer. · How many participants have never used DS? 59% of the population in the current study. This is shown in Figure 3. · Table 6 in education, I did not see the illiterate group in the Determinants. It is available but said “ uneducated”. We will change it to be consistent. Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank you for this comment. The introduction was amended based on your comments. We are worried about DS use because Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. This was mentioned in lines 56-60. -May be need some information about % Dm in Lebanon or DS use ? There is no information concerning DS use among patients with diabetes type 2 in Lebanon but we already mentioned that we already assessed DS use among: children under 5 and their mothers, adults and athletes. This was added in lines 62-64. - Does the objective to assess DS among all individuals with DM or only Type 2? This is mentioned in rationale, objectives and methodology: patients with type 2 diabetes only. -Methods : - Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” The whole paragraph was amended. Inclusion/ exclusion criteria, “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? Yes these patients were also excluded. This was amended in the same paragraph. What about other diseases such as Celiac or food allergies. Are those excluded? This was not mentioned as an exclusion criterion. However, none of our patients were having these diseases because we were collecting the medical history of the patients. All patients who were excluded were having abnormal levels of glycemia, confirmed having type 2 diabetes and not diabetes type 1. Regarding the KSP. More information is needed about scoring. does the questions with one option. As mentioned in the “Methodology” section, the questions were having multiple responses for instance the Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. There was no single score, but we were showing the response of the patients. We are planning in future studies to validate this score. Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. We already mention in “Methodology” that we are assessing the current use of the DS by the patients. The answers of these questions are mentioned in Table 4 showing the frequency of the current use by the patients (per day, week, month…). The use of pills was most considered compared to the quantity. Based on that the frequency was our main objective. Results : Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? This was presented in Table 6 which shows that people who are educated had an 1.4-3.9 higher odd of using DS compared to those who are illiterate. · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? Newly diagnosed are those who were diagnosed in the same year. The other sub-groups are defined as 1-5 years. This was amended in the manuscript and the tables. · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? All patients with DT1 were excluded. And yes only patients with type 2 DM were included in the study. · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? 86% of participants know and heard about DS and 14% don’t know about it. We only highlighted the answer “Yes” and “Don’t Know”. However, we amended Figure 1. Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? Based on the study source of the questionnaire, these questions were related to knowledge questions. · Be consistent with decimals This was amended in the manuscript. · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. This sentence was added to the Figures in the manuscript to make it more clearer. · How many participants have never used DS? 59% of the population in the current study. This is shown in Figure 3. · Table 6 in education, I did not see the illiterate group in the Determinants. It is available but said “ uneducated”. We will change it to be consistent. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Jul 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jul 2024 Author Response Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank ... Continue reading Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank you for this comment. The introduction was amended based on your comments. We are worried about DS use because Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. This was mentioned in lines 56-60. -May be need some information about % Dm in Lebanon or DS use ? There is no information concerning DS use among patients with diabetes type 2 in Lebanon but we already mentioned that we already assessed DS use among: children under 5 and their mothers, adults and athletes. This was added in lines 62-64. - Does the objective to assess DS among all individuals with DM or only Type 2? This is mentioned in rationale, objectives and methodology: patients with type 2 diabetes only. -Methods : - Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” The whole paragraph was amended. Inclusion/ exclusion criteria, “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? Yes these patients were also excluded. This was amended in the same paragraph. What about other diseases such as Celiac or food allergies. Are those excluded? This was not mentioned as an exclusion criterion. However, none of our patients were having these diseases because we were collecting the medical history of the patients. All patients who were excluded were having abnormal levels of glycemia, confirmed having type 2 diabetes and not diabetes type 1. Regarding the KSP. More information is needed about scoring. does the questions with one option. As mentioned in the “Methodology” section, the questions were having multiple responses for instance the Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. There was no single score, but we were showing the response of the patients. We are planning in future studies to validate this score. Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. We already mention in “Methodology” that we are assessing the current use of the DS by the patients. The answers of these questions are mentioned in Table 4 showing the frequency of the current use by the patients (per day, week, month…). The use of pills was most considered compared to the quantity. Based on that the frequency was our main objective. Results : Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? This was presented in Table 6 which shows that people who are educated had an 1.4-3.9 higher odd of using DS compared to those who are illiterate. · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? Newly diagnosed are those who were diagnosed in the same year. The other sub-groups are defined as 1-5 years. This was amended in the manuscript and the tables. · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? All patients with DT1 were excluded. And yes only patients with type 2 DM were included in the study. · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? 86% of participants know and heard about DS and 14% don’t know about it. We only highlighted the answer “Yes” and “Don’t Know”. However, we amended Figure 1. Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? Based on the study source of the questionnaire, these questions were related to knowledge questions. · Be consistent with decimals This was amended in the manuscript. · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. This sentence was added to the Figures in the manuscript to make it more clearer. · How many participants have never used DS? 59% of the population in the current study. This is shown in Figure 3. · Table 6 in education, I did not see the illiterate group in the Determinants. It is available but said “ uneducated”. We will change it to be consistent. Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank you for this comment. The introduction was amended based on your comments. We are worried about DS use because Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. This was mentioned in lines 56-60. -May be need some information about % Dm in Lebanon or DS use ? There is no information concerning DS use among patients with diabetes type 2 in Lebanon but we already mentioned that we already assessed DS use among: children under 5 and their mothers, adults and athletes. This was added in lines 62-64. - Does the objective to assess DS among all individuals with DM or only Type 2? This is mentioned in rationale, objectives and methodology: patients with type 2 diabetes only. -Methods : - Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” The whole paragraph was amended. Inclusion/ exclusion criteria, “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? Yes these patients were also excluded. This was amended in the same paragraph. What about other diseases such as Celiac or food allergies. Are those excluded? This was not mentioned as an exclusion criterion. However, none of our patients were having these diseases because we were collecting the medical history of the patients. All patients who were excluded were having abnormal levels of glycemia, confirmed having type 2 diabetes and not diabetes type 1. Regarding the KSP. More information is needed about scoring. does the questions with one option. As mentioned in the “Methodology” section, the questions were having multiple responses for instance the Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. There was no single score, but we were showing the response of the patients. We are planning in future studies to validate this score. Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. We already mention in “Methodology” that we are assessing the current use of the DS by the patients. The answers of these questions are mentioned in Table 4 showing the frequency of the current use by the patients (per day, week, month…). The use of pills was most considered compared to the quantity. Based on that the frequency was our main objective. Results : Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? This was presented in Table 6 which shows that people who are educated had an 1.4-3.9 higher odd of using DS compared to those who are illiterate. · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? Newly diagnosed are those who were diagnosed in the same year. The other sub-groups are defined as 1-5 years. This was amended in the manuscript and the tables. · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? All patients with DT1 were excluded. And yes only patients with type 2 DM were included in the study. · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? 86% of participants know and heard about DS and 14% don’t know about it. We only highlighted the answer “Yes” and “Don’t Know”. However, we amended Figure 1. Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? Based on the study source of the questionnaire, these questions were related to knowledge questions. · Be consistent with decimals This was amended in the manuscript. · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. This sentence was added to the Figures in the manuscript to make it more clearer. · How many participants have never used DS? 59% of the population in the current study. This is shown in Figure 3. · Table 6 in education, I did not see the illiterate group in the Determinants. It is available but said “ uneducated”. We will change it to be consistent. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Hallit R. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275466 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275466 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 10 May 2024 Rabih Hallit , Holy Spirit University of Kaslik, Jounieh, Lebanon Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.161131.r275466 Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is ... Continue reading READ ALL Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Infectious disease and internal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Hallit R. Reviewer Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275466 ) The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275466 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 26 Jun 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jun 2024 Author Response Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order ... Continue reading Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Competing Interests: No competing interests Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 26 Jun 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jun 2024 Author Response Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order ... Continue reading Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Competing Interests: No competing interests Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (1) Version 2 VERSION 2 PUBLISHED 26 Jul 2024 Revised Comment ADD YOUR COMMENT Version 1 VERSION 1 PUBLISHED 01 May 2024 Discussion is closed on this version, please comment on the latest version above. Author Response 26 Jun 2024 Maha Hoteit , Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon 26 Jun 2024 Author Response Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order ... Continue reading Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done Competing Interests: No competing interests Close Report a concern Discussion is closed on this version, please comment on the latest version above. keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 2 (revision) 26 Jul 24 read read Version 1 01 May 24 read read Rabih Hallit , Holy Spirit University of Kaslik, Jounieh, Lebanon Abeer Salman Alzaben , Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia Comments on this article All Comments (1) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Alzaben A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Aug 2024 | for Version 2 Abeer Salman Alzaben , Department of Health Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh Province, Saudi Arabia 0 Views copyright © 2024 Alzaben A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for making the required changes. Competing Interests No competing interests were disclosed. I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Alzaben AS. Peer Review Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307414) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307414 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Hallit R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 27 Jul 2024 | for Version 2 Rabih Hallit , Holy Spirit University of Kaslik, Jounieh, Lebanon 0 Views copyright © 2024 Hallit R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Dear authors, thank you for the changes made. No more comments from my side. Good luck! Competing Interests No competing interests were disclosed. Reviewer Expertise Infectious disease and internal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Hallit R. Peer Review Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.168897.r307415) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-432/v2#referee-response-307415 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Alzaben A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Jun 2024 | for Version 1 Abeer Salman Alzaben , Department of Health Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Riyadh Province, Saudi Arabia 0 Views copyright © 2024 Alzaben A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for providing me the opportunity to review the manuscript. below some of my comments to make the manuscript more clear: Introduction : · Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? . may be need some information about % Dm in Lebanon or DS use ? · Does the objective to assess DS among all individuals with DM or only Type 2? Methods : · Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” Inclusion/ exclusion criteria, · “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? · What about other disease such as Celiac or food allergies. Are those excluded? · Regarding the KSP. More information is needed about scoring. does the questions with one option · Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. Results : · Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? · Be consistent with decimals · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. · How many participants have never used DS? · Table 6 in education, I did not see the illiterate group in the Determinants. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? No source data required Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Nutrition I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 26 Jul 2024 Maha Hoteit, Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon Introduction : - Introduction is too short and lack of the rational. If there is shortage in medicine in Lebanon. why the authors worry about DS? Thank you for this comment. The introduction was amended based on your comments. We are worried about DS use because Lebanese patients with type 2 diabetes mellitus (T2DM) are experiencing medicine shortages with rise in medication prices, which leads the patients to be incapable of buying their medical drugs. This deviation increased the health risk for these patients and increased the use and abuse of dietary supplements (DS). This increase may be due to several factors, including patients' perceptions that DS's natural products are safer, more effective, and cheaper than conventional medicines. This was mentioned in lines 56-60. -May be need some information about % Dm in Lebanon or DS use ? There is no information concerning DS use among patients with diabetes type 2 in Lebanon but we already mentioned that we already assessed DS use among: children under 5 and their mothers, adults and athletes. This was added in lines 62-64. - Does the objective to assess DS among all individuals with DM or only Type 2? This is mentioned in rationale, objectives and methodology: patients with type 2 diabetes only. -Methods : - Please correct “convenient sample size was collected from all governorates in Lebanon. A total of 460 patients with T2DM were enrolled in this survey to “convenient sample technique” The whole paragraph was amended. Inclusion/ exclusion criteria, “The exclusion criteria were individuals under the age of 18 years because of the high probability of having type 1 diabetes mellitus at this age.” Some individuals maybe older than 18 with type 1. Are those excluded? Yes these patients were also excluded. This was amended in the same paragraph. What about other diseases such as Celiac or food allergies. Are those excluded? This was not mentioned as an exclusion criterion. However, none of our patients were having these diseases because we were collecting the medical history of the patients. All patients who were excluded were having abnormal levels of glycemia, confirmed having type 2 diabetes and not diabetes type 1. Regarding the KSP. More information is needed about scoring. does the questions with one option. As mentioned in the “Methodology” section, the questions were having multiple responses for instance the Table 3 displays the results of the participants’ attitudes based on a Likert scale scoring system consisting of responses of strongly agree, agree, neutral, disagree, and strongly disagree. There was no single score, but we were showing the response of the patients. We are planning in future studies to validate this score. Regarding the use of DS, I feel the questions/information are not clear. Do you mean they are currently use? Past use? If past use, how frequent? If a person has taken 1 pill in the last year. How you consider this? Need more clarifications. We already mention in “Methodology” that we are assessing the current use of the DS by the patients. The answers of these questions are mentioned in Table 4 showing the frequency of the current use by the patients (per day, week, month…). The use of pills was most considered compared to the quantity. Based on that the frequency was our main objective. Results : Table 1: You had 14 % illiterate. Do you think those are significantly different in KSP and DS use than others? This was presented in Table 6 which shows that people who are educated had an 1.4-3.9 higher odd of using DS compared to those who are illiterate. · Duration of Disease newly diagnosis vs < 5 years. I would say 1- 5 years are not newly diagnosis. Can you separate them as one subgroup? Newly diagnosed are those who were diagnosed in the same year. The other sub-groups are defined as 1-5 years. This was amended in the manuscript and the tables. · For me, it is still not clear, all sample with type 2 DM? Did you exclude type 1? All patients with DT1 were excluded. And yes only patients with type 2 DM were included in the study. · Figure 1, x axis refers to % but the sum does not = 100%, have you heard about DS is = 86 %? 86% of participants know and heard about DS and 14% don’t know about it. We only highlighted the answer “Yes” and “Don’t Know”. However, we amended Figure 1. Figure 1 there are 2 option yes and don’t know what about no ? In addition, the knowledge items that have been asked are not knowledge questions, maybe awareness? Based on the study source of the questionnaire, these questions were related to knowledge questions. · Be consistent with decimals This was amended in the manuscript. · Figure 2 not clear. what does the bar stand for? I think you need to work on all your figure legends. explain what X and Y axis means, it refers to n number or %. X axis refers to the percentage of patients responding to the questions raised in Y axis. Only “Yes” responses are shown in this Figure. This sentence was added to the Figures in the manuscript to make it more clearer. · How many participants have never used DS? 59% of the population in the current study. This is shown in Figure 3. · Table 6 in education, I did not see the illiterate group in the Determinants. It is available but said “ uneducated”. We will change it to be consistent. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Alzaben AS. Peer Review Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275467) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275467 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Hallit R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 10 May 2024 | for Version 1 Rabih Hallit , Holy Spirit University of Kaslik, Jounieh, Lebanon 0 Views copyright © 2024 Hallit R. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Infectious disease and internal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 26 Jun 2024 Maha Hoteit, Faculty of Public Health, Section 1, Lebanese University, Beirut, Lebanon Thank you for inviting me to review this paper. Dear authors, Thank you for this paper. I have some comments that you might want to take into account in order to improve its quality: -The introduction is too short and can be easily expanded. You did not introduce the idea of dietary supplements, the knowledge, attitude and practice about these supplements according to previous international studies. Author Response: Done -Rationale is missing: why is it important to conduct this study in patients with diabetes? The fact that the same study was conducted among patients with other diseases is not sufficient. Author Response: Done -Your first objective needs to be introduced. What is the relation of the economic crisis in Lebanon with your study and with the use of dietary supplements in patients with diabetes? Author Response: Done -In section 2.3, how did you build the questionnaire? based on previous studies or you created your own scale? I suggest adding the questionnaire as an appendix with the right answers for the knowledge questions most importantly. Author Response: It was built based on previous published studies with no major changes and all the tools are already available on: Hoteit M: Dietary Supplement and Diabetes type II. [Dataset]. OSF. 2024. Publisher Full Text (reference 44 in the manuscript). As for the responses to knowledge, attitudes and practices, they are already mentioned in the Figures and tables in the manuscript itself. -The results lack the bivariate analyses. Please add them and then you enter in the multivariable model all variables that showed a p < 0.25 in the bivariate analysis only. Author Response: Bivariate analyses are already shown in Table 6. -The discussion is good but it needs adjustment maybe after implementing the changes to the results. Author Response: Done -Please add the clinical implications paragraph to the discussion: how would other healthcare professionals benefit from your study? Author Response: Done View more View less Competing Interests No competing interests reply Respond Report a concern Hallit R. Peer Review Report For: Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study [version 2; peer review: 2 approved] . F1000Research 2024, 13 :432 ( https://doi.org/10.5256/f1000research.161131.r275466) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-432/v1#referee-response-275466 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Stay Updated Sign up for content alerts and receive a weekly or monthly email with all newly published articles Register with F1000Research Already registered? Sign in Not now, thanks close PLEASE NOTE If you are an AUTHOR of this article, please check that you signed in with the account associated with this article otherwise we cannot automatically identify your role as an author and your comment will be labelled as a “User Comment”. If you are a REVIEWER of this article, please check that you have signed in with the account associated with this article and then go to your account to submit your report, please do not post your review here. If you do not have access to your original account, please contact us . All commenters must hold a formal affiliation as per our Policies . The information that you give us will be displayed next to your comment. User comments must be in English, comprehensible and relevant to the article under discussion. We reserve the right to remove any comments that we consider to be inappropriate, offensive or otherwise in breach of the User Comment Terms and Conditions . Commenters must not use a comment for personal attacks. When criticisms of the article are based on unpublished data, the data should be made available. I accept the User Comment Terms and Conditions Please confirm that you accept the User Comment Terms and Conditions. Affiliation ✕ refresh Please enter your institution. Note: To add your institution or organisation, start typing the name and then select the correct name from the list. Where applicable, the name will appear in both the original language and in English. Do not paste in the name. If the name does not appear in the drop-down list, we will display the information you have entered. ✕ refresh Country/Region * USA UK Canada China France Germany Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo (Serbia and Montenegro) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Minor Outlying Islands of the United States Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Is South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Gambia The Netherlands Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu UK USA Uganda Ukraine United Arab Emirates United States Virgin Islands Uruguay Uzbekistan Vanuatu Venezuela Vietnam Wallis and Futuna West Bank and Gaza Strip Western Sahara Yemen Zambia Zimbabwe Please select your country/region. You must enter a comment. Competing Interests Please disclose any competing interests that might be construed to influence your judgment of the article's or peer review report's validity or importance. Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. Consider the following examples, but note that this is not an exhaustive list: Examples of 'Non-Financial Competing Interests' Within the past 4 years, you have held joint grants, published or collaborated with any of the authors of the selected paper. You have a close personal relationship (e.g. parent, spouse, sibling, or domestic partner) with any of the authors. You are a close professional associate of any of the authors (e.g. scientific mentor, recent student). You work at the same institute as any of the authors. You hope/expect to benefit (e.g. favour or employment) as a result of your submission. You are an Editor for the journal in which the article is published. Examples of 'Financial Competing Interests' You expect to receive, or in the past 4 years have received, any of the following from any commercial organisation that may gain financially from your submission: a salary, fees, funding, reimbursements. You expect to receive, or in the past 4 years have received, shared grant support or other funding with any of the authors. You hold, or are currently applying for, any patents or significant stocks/shares relating to the subject matter of the paper you are commenting on. Please state your competing interests The comment has been saved. An error has occurred. Please try again. Cancel Post var lTitle = "Knowledge, attitudes, and practices of Lebanese...".replace("'", ''); var linkedInUrl = "http://www.linkedin.com/shareArticle?url=https://f1000research.com/articles/13-432/v2" + "&title=" + encodeURIComponent(lTitle) + "&summary=" + encodeURIComponent('Read the article by '); var deliciousUrl = "https://del.icio.us/post?url=https://f1000research.com/articles/13-432/v2&title=" + encodeURIComponent(lTitle); var redditUrl = "http://reddit.com/submit?url=https://f1000research.com/articles/13-432/v2" + "&title=" + encodeURIComponent(lTitle); linkedInUrl += encodeURIComponent('Abdallah M et al.'); var offsetTop = /chrome/i.test( navigator.userAgent ) ? 4 : -10; var addthis_config = { ui_offset_top: offsetTop, services_compact : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_expanded : "facebook,twitter,www.linkedin.com,www.mendeley.com,reddit.com", services_custom : [ { name: "LinkedIn", url: linkedInUrl, icon:"/img/icon/at_linkedin.svg" }, { name: "Mendeley", url: "http://www.mendeley.com/import/?url=https://f1000research.com/articles/13-432/v2/mendeley", icon:"/img/icon/at_mendeley.svg" }, { name: "Reddit", url: redditUrl, icon:"/img/icon/at_reddit.svg" }, ] }; var addthis_share = { url: "https://f1000research.com/articles/13-432", templates : { twitter : "Knowledge, attitudes, and practices of Lebanese patients with.... Abdallah M et al., published by " + "@F1000Research" + ", https://f1000research.com/articles/13-432/v2" } }; if (typeof(addthis) != "undefined"){ addthis.addEventListener('addthis.ready', checkCount); addthis.addEventListener('addthis.menu.share', checkCount); } $(".f1r-shares-twitter").attr("href", "https://twitter.com/intent/tweet?text=" + addthis_share.templates.twitter); $(".f1r-shares-facebook").attr("href", "https://www.facebook.com/sharer/sharer.php?u=" + addthis_share.url); $(".f1r-shares-linkedin").attr("href", addthis_config.services_custom[0].url); $(".f1r-shares-reddit").attr("href", addthis_config.services_custom[2].url); $(".f1r-shares-mendelay").attr("href", addthis_config.services_custom[1].url); function checkCount(){ setTimeout(function(){ $(".addthis_button_expanded").each(function(){ var count = $(this).text(); if (count !== "" && count != "0") $(this).removeClass("is-hidden"); else $(this).addClass("is-hidden"); }); }, 1000); } close How to cite this report {{reportCitation}} Cancel Copy Citation Details $(function(){R.ui.buttonDropdowns('.dropdown-for-downloads');}); $(function(){R.ui.toolbarDropdowns('.toolbar-dropdown-for-downloads');}); $.get("/articles/acj/146998/168897") new F1000.Clipboard(); new F1000.ThesaurusTermsDisplay("articles", "article", "168897"); $(document).ready(function() { $( "#frame1" ).on('load', function() { var mydiv = $(this).contents().find("div"); var h = mydiv.height(); console.log(h) }); var tooltipLivingFigure = jQuery(".interactive-living-figure-label .icon-more-info"), titleLivingFigure = tooltipLivingFigure.attr("title"); tooltipLivingFigure.simpletip({ fixed: true, position: ["-115", "30"], baseClass: 'small-tooltip', content:titleLivingFigure + " " }); tooltipLivingFigure.removeAttr("title"); $("body").on("click", ".cite-living-figure", function(e) { e.preventDefault(); var ref = $(this).attr("data-ref"); $(this).closest(".living-figure-list-container").find("#" + ref).fadeIn(200); }); $("body").on("click", ".close-cite-living-figure", function(e) { e.preventDefault(); $(this).closest(".popup-window-wrapper").fadeOut(200); }); $(document).on("mouseup", function(e) { var metricsContainer = $(".article-metrics-popover-wrapper"); if (!metricsContainer.is(e.target) && metricsContainer.has(e.target).length === 0) { $(".article-metrics-close-button").click(); } }); var articleId = $('#articleId').val(); if($("#main-article-count-box").attachArticleMetrics) { $("#main-article-count-box").attachArticleMetrics(articleId, { articleMetricsView: true }); } }); var figshareWidget = $(".new_figshare_widget"); if (figshareWidget.length > 0) { window.figshare.load("f1000", function(Widget) { // Select a tag/tags defined in your page. In this tag we will place the widget. _.map(figshareWidget, function(el){ var widget = new Widget({ articleId: $(el).attr("figshare_articleId") //height:300 // this is the height of the viewer part. [Default: 550] }); widget.initialize(); // initialize the widget widget.mount(el); // mount it in a tag that's on your page // this will save the widget on the global scope for later use from // your JS scripts. This line is optional. //window.widget = widget; }); }); } close Error Close Add Reset F1000.MICROSERVICES.AFFILIATION = ''; $(document).ready(function () { $('.js-affiliations-form').each((index, form) => { new AffiliationForm({ formId: form.id, institutionErrorSelector: '.comment-enter-institution', departmentErrorSelector: '.comment-enter-department', placeSelector: '.js-add-comment-place', stateSelector: '.js-add-comment-state', zipCodeSelector: '.js-add-comment-zipcode', countrySelector: '.js-add-comment-country', countryErrorSelector: '.comment-enter-country', }); }); }); $(document).ready(function () { var reportIds = { "275468": 0, "275469": 0, "275470": 0, "275471": 0, "275466": 17, "275467": 17, "309012": 0, "309013": 0, "307414": 18, "309014": 0, "307415": 7, "309015": 0, "309011": 0, "309020": 0, "309016": 0, "309017": 0, "309018": 0, "309019": 0, "280630": 0, "280631": 0, "280636": 0, "280637": 0, "280638": 0, "280639": 0, "280632": 0, "280633": 0, "280634": 0, "280635": 0, }; $(".referee-response-container,.js-referee-report").each(function(index, el) { var reportId = $(el).attr("data-reportid"), reportCount = reportIds[reportId] || 0; $(el).find(".comments-count-container,.js-referee-report-views").html(reportCount); }); var uuidInput = $("#article_uuid"), oldUUId = uuidInput.val(), newUUId = "3ae91ac4-cd6e-4af7-b70c-ba5b6c0238c3"; uuidInput.val(newUUId); $("a[href*='article_uuid=']").each(function(index, el) { var newHref = $(el).attr("href").replace(oldUUId, newUUId); $(el).attr("href", newHref); }); }); An innovative open access publishing platform offering rapid publication and open peer review, whilst supporting data deposition and sharing. Browse Gateways Collections How it Works Contact For Developers Cookie Notice Privacy Notice RSS Submit Your Research Follow us © 2012-2026 F1000 Research Ltd. ISSN 2046-1402 | Legal | Partner of Research4Life • CrossRef • ORCID • FAIRSharing R.templateTests.simpleTemplate = R.template(' $text $text $text $text $text '); R.templateTests.runTests(); var F1000platform = new F1000.Platform({ name: "f1000research", displayName: "F1000Research", hostName: "f1000research.com", id: "1", editorialEmail: "[email protected]", infoEmail: "[email protected]", usePmcStats: true }); $(function(){R.ui.dropdowns('.dropdown-for-authors, .dropdown-for-about, .dropdown-for-myresearch');}); // $(function(){R.ui.dropdowns('.dropdown-for-referees');}); $(document).ready(function () { if ($(".cookie-warning").is(":visible")) { $(".sticky").css("margin-bottom", "35px"); $(".devices").addClass("devices-and-cookie-warning"); } $(".cookie-warning .close-button").click(function (e) { $(".devices").removeClass("devices-and-cookie-warning"); $(".sticky").css("margin-bottom", "0"); }); $("#tweeter-feed .tweet-message").each(function (i, message) { var self = $(message); self.html(linkify(self.html())); }); $(".partner").on("mouseenter mouseleave", function() { $(this).find(".gray-scale, .colour").toggleClass("is-hidden"); }); }); Sign In Remember me Forgotten your password? Sign In Cancel Email or password not correct. Please try again Please wait... $(function(){ // Note: All the setup needs to run against a name attribute and *not* the id due the clonish // nature of facebox... $("a[id=googleSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("GOOGLE"); $("form[id=oAuthForm]").submit(); }); $("a[id=facebookSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("FACEBOOK"); $("form[id=oAuthForm]").submit(); }); $("a[id=orcidSignInButton]").click(function(event){ event.preventDefault(); $("input[id=oAuthSystem]").val("ORCID"); $("form[id=oAuthForm]").submit(); }); }); If you've forgotten your password, please enter your email address below and we'll send you instructions on how to reset your password. The email address should be the one you originally registered with F1000. Email address not valid, please try again You registered with F1000 via Google, so we cannot reset your password. To sign in, please click here . If you still need help with your Google account password, please click here . You registered with F1000 via Facebook, so we cannot reset your password. To sign in, please click here . If you still need help with your Facebook account password, please click here . Code not correct, please try again Reset password Cancel Email us for further assistance. Server error, please try again. If your email address is registered with us, we will email you instructions to reset your password. If you think you should have received this email but it has not arrived, please check your spam filters and/or contact for further assistance. Please wait... Register $(document).ready(function () { signIn.createSignInAsRow($("#sign-in-form-gfb-popup")); $(".target-field").each(function () { var uris = $(this).val().split("/"); if (uris.pop() === "login") { $(this).val(uris.toString().replace(",","/")); } }); });