Reviewer's report 
 Asymptomatic Bacteriuria in type 2 Iranian diabetic women : a cross sectional study Title: 
 1  29 June 2005 Version: Date: 
 Wendy A Davis Reviewer: 
Reviewer's report: 
General 
The objectives of the study (to determine the prevalence and risk factors of asymptomatic 
bacteriuria (ASB) in women with type 2 diabetes in an Iranian population) are sound. The research although not novel, will add to the global data on ASB prevalence in diabetes. ------------------------------------------------------------------------------- 
Major Compulsory Revisions (that the author must respond to before a decision on publication can 
be reached) 
1. The paper requires editing by a native English speaker for both spelling and grammar. 2. The authors need the help of a biostatistician. For example, duration of diabetes and HbA1c are 
not normally distributed and should be presented as medians [interquartile range, 25%-75%]. The 
appropriate test for two independent group comparisons for these is the non-parametric Mann-Witney U-test. Dichotomous variables should be compared with Fishers exact test (or 
chi-squared test) and ordinal variables with the chi-squared test. Rather than categorize continuous 
variables, it would be better to analyse them as continuous variables since information is lost when 
data are categorized. This might explain some of the non-significant findings. Multiple logistic 
regression analysis with ASB as the dependent variable should be undertaken to determine 
independent associates of prevalent ASB. The variables in the sample size equation need defining. 
It may not be the most appropriate one to use. 
3. Abstract (Methods): The authors need to specify that the sample was clinic-based. 
4. Methods: What was the response rate (i.e. what proportion of women who were asked to 
participate did so)? Specify whether the blood samples were taken fasting. Define macroalbuminuria 
by dipstick in more detail. Was urinary albumin:creatinine ratio also measured to define 
macroalbuminuria? Specify how patients were defined with type 2 diabetes. The WHO definition is 
quoted but it is unclear how the patients were identified in practice for the study. 5. Results: In Table 1 and the text, the authors need to be consistent with the number of decimal 
points used for mean and standard deviation. Annotate Table 3 so that it is understandable to the 
non-expert. Define hpf. 3rd paragraph: 80.8%, 4.5%, 8.5% and 68.8 do not add up to 100%. The results would be best presented as a Table. Combine it with Table 1 and include the P-values. 6. Conclusions: Specify the settings of the other studies that were compared with yours. For 
example, Kayimas study was clinic-based in Nairobi, Kenya, Zhanels was also clinic-based from 
Manitoba, Canada, whilst Geerlings was a multi-centre study in the Netherlands with patients recruited from diabetic outpatient clinics and General Practitioner offices. I could not find Alebiosus paper on Medline. Please check the reference. Also, the prevalence in Kayimas study was 11.1% 
(not 11.2%) and the most appropriate comparison in Geerlings study is the prevalence of ASB in 
type 2s (29.6%). Why do you think the prevalence in Geerlings study is higher than in the others? Define OPD. A cross-sectional study such as this can suggest associates of prevalent ASB but cannot prove causality. Thus, pyuria and glucosuria may be associated with ASB but are not 
necessarily risk factors for the development of ASB. P-values repeated from the results section 
could be deleted. In concluding, the authors may want to discuss what the clinical sequelae of ASB might be (i.e. why is it important to detect ASB?). Geerlings paper addresses this as does: Karunajeewa H, McGechie D, Stuccio G, Stingemore N, Davis WA, Davis TM. Asymptomatic 
bacteriuria as a predictor of subsequent hospitalisation with urinary tract infection in diabetic adults: 
The Fremantle Diabetes Study. Diabetologia. 2005 May 26; [Epub ahead of print] 
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Minor Essential Revisions (such as missing labels on figures, or the wrong use of a term, which the author can be trusted to correct) 
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Discretionary Revisions (which the author can choose to ignore) 
 Unable to decide on acceptance or rejection until the authors have responded to the What next?: 
major compulsory revisions 
 An article whose findings are important to those with closely related research Level of interest: 
interests 
 Needs some language corrections before being published Quality of written English: 
 Yes Statistical review: 
Declaration of competing interests: 
I declare that I have no competing interests.