Comment on: risk factors associated with prediabetes-to-diabetes conversion in a majority-minority county: a real-world analysis.

We read with interest the article by Lee et al. examining risk factors associated with progression from prediabetes to type 2 diabetes mellitus in a majority-minority population. The study provides valuable real-world evidence on an important public health issue; however, several methodological considerations require further discussion. The retrospective design based on electronic health record data may be susceptible to selection bias and inaccuracies inherent to observational research. Additionally, reliance on International Classification of Diseases (ICD) codes raises the possibility of disease misclassification due to coding errors and incomplete documentation. Concerns also exist regarding the handling of missing data and loss to follow-up, as patients at higher risk of diabetes progression may have been disproportionately censored, potentially influencing risk estimates. Furthermore, the potential impact of glucose-lowering medications other than metformin, such as GLP-1 agonists and SGLT2 inhibitors, was not addressed. Greater acknowledgment of these limitations would strengthen the interpretation, transparency, and generalizability of the study findings.