Review Article | DOI: https://doi.org/10.31579/2690-8794/344
1Department of Family Medicine, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye.
2Department of Emergency Medicine, University of Health Sciences, Gaziosmanpasa Training and Research Hospital, Istanbul, Türkiye.
3Department of Internal Medicine, Gaziantep Islam Science and Technology University School of Medicine, Gaziantep Türkiye.
*Corresponding Author: Mehmet Akif Buyukbese, Department of Internal Medicine, Gaziantep Islam Science and Technology University School of Medicine, Gaziantep Türkiye.
Citation: Melike M. Baspinar, Ibrahim Sarbay, Mehmet A. Buyukbese, (2026), Smoking Exposure and Severe Hypoglycemia in Diabetes: A PRISMA-ScR Scoping Review of Population-Based Evidence, Clinical Medical Reviews and Reports, 8(7); DOI:10.31579/2690-8794/344
Copyright: © 2026, Mehmet Akif Buyukbese. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 22 June 2026 | Accepted: 01 July 2026 | Published: 16 July 2026
Keywords: diabetes mellitus; hypoglycemia; smoking; risk factor; scoping review
Background: Hypoglycemia is a major acute complication of diabetes mellitus that limits safe glycemic management. Although smoking is a well-recognized cardiovascular risk factor in diabetes, its role as a risk modifier for severe hypoglycemia has received limited systematic attention. This scoping review aimed to map and synthesize observational and population-based evidence on the association between smoking exposure and hypoglycemia across different diabetes types and severity levels.
Methods: Conducted in accordance with PRISMA-ScR guidelines, this review systematically searched PubMed and Web of Science databases. From 440 identified records, 234 articles were screened after deduplication, and 19 studies were ultimately included, encompassing nationwide cohort studies, retrospective analyses, cross-sectional investigations, systematic reviews, and health economic models, with a combined population exceeding 4.5 million individuals with type 1 or type 2 diabetes.
Results: Large population-based cohort studies consistently demonstrated an increased risk of medically attended severe hypoglycemia among current smokers (HR/OR range: 1.17–1.35). Lifestyle composite analyses revealed dose-response relationships, with hazard ratios reaching 1.81 when smoking was combined with other unhealthy behaviors. Meta-analytic evidence in type 1 diabetes confirmed smoking as an independent risk factor (OR 1.17; 95% CI: 1.07–1.28). Continuous glucose monitoring studies reported a nearly two-fold higher rate of severe hypoglycemia in smokers. Smoking was also associated with elevated hypoglycemia-related mortality in type 1 diabetes (HR 2.86; 95% CI: 1.57–5.22).
Conclusion: Smoking is a consistent, independent, and modifiable risk factor for severe hypoglycemia in individuals with diabetes mellitus. Integrating smoking cessation into comprehensive diabetes care may reduce acute hypoglycemic complications and associated morbidity and mortality.
Graphical Abstract: The Smoking Risk: Key findings from this scoping review illustrating the quantified risk gradient between smoking and severe hypoglycemia, the biological and behavioral mechanisms involved, and the proposed clinical solutions.
Diabetes mellitus (DM) is one of the most prevalent non-communicable diseases globally, affecting an estimated 537 million adults in 2021, with projections of 852.5 million by 2050 [1–3]. In Türkiye specifically, the age-adjusted prevalence of diabetes has risen substantially over the past two decades, with recent forecasts estimating a prevalence of 17.5% by 2030 and 19.2% by 2045 [4, 5]. The increasing disease burden underscores the urgency of identifying modifiable risk factors that can be addressed within routine clinical care.
Hypoglycemia is a major limiting factor in glycemic management for both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) [6]. Severe hypoglycemia (SH) — defined as an episode requiring external assistance for recovery — is associated with significant clinical consequences, including cardiovascular events, arrhythmias, cognitive dysfunction, hospitalization, and mortality [7, 8]. Glycemic variability, which reflects the dynamic interplay between hyperglycemia and hypoglycemia, further amplifies oxidative stress and inflammatory burden [6]. Effective diabetes management therefore requires an integrated approach combining pharmacotherapy optimization with lifestyle modification, including smoking cessation [1, 5].
Smoking exacerbates insulin resistance and impairs glycemic control, thereby increasing the risk of microvascular and macrovascular complications, including neuropathy, retinopathy, and cardiovascular disease [9, 10]. Studies in populations without prior diabetes have established that active smoking increases the risk of incident T2DM through multiple mechanisms, including impairment of pancreatic beta-cell function and enhancement of peripheral insulin resistance [11, 12]. In individuals with established diabetes, smoking cessation has been associated with reductions in fasting plasma glucose and HbA1c levels [13]. However, evidence specifically addressing the relationship between smoking and hypoglycemia in diabetes management remains fragmented.
This scoping review aimed to systematically map the multifaceted evidence on the association between smoking exposure and hypoglycemia in individuals with DM. Specifically, we sought to examine: (1) whether smoking is associated with an increased risk of hypoglycemia; (2) whether this risk differs between T1DM and T2DM; (3) whether the association varies according to hypoglycemia severity; and (4) the overall strength, consistency, and certainty of the existing evidence. By integrating these dimensions, this review seeks to inform risk-stratified and proactive clinical strategies for hypoglycemia prevention.
Study Design and Framework
This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. The methodology was designed to systematically map the extant literature and identify key evidence regarding the association between smoking and hypoglycemia in individuals with diabetes.
Search Strategy and Information Sources
A systematic literature search was performed in two principal electronic databases: PubMed and Web of Science (WoS). The search strategy incorporated a combination of Medical Subject Headings (MeSH) terms and free-text keywords pertaining to “Diabetes,” “Hypoglycemia,” and “Smoking.”
PubMed (n = 148): (("Diabetes Mellitus"[Mesh] OR diabetes OR "diabetes mellitus") AND ("Hypoglycemia"[Mesh] OR hypoglycemia OR hypoglycaemia) AND ("Smoking"[Mesh] OR smoking OR tobacco OR nicotine))
Web of Science (n = 292): TS=((diabetes OR "diabetes mellitus" OR diabetic*) AND (hypoglycemia OR hypoglycaemia OR "low blood sugar") AND (smoking OR smoker* OR cigarette* OR tobacco OR nicotine OR "tobacco use"))
Study Selection and Eligibility Criteria
Following the initial search, 440 records were identified. After removing 206 duplicates, 234 unique articles remained for title and abstract screening. Of these, 124 were excluded due to wrong outcome (n = 88) or wrong population (n = 36). A further 77 records could not be retrieved in full text. Of 33 articles assessed for full-text eligibility, 14 were subsequently excluded (wrong association, n = 8; wrong study design, n = 4; other, n = 2), yielding a final sample of 19 studies for synthesis. The complete selection process is depicted in Figure 1 (PRISMA flow diagram).
Figure 1: Prisma -ScR flow diagram of study
Predefined inclusion criteria were applied as follows:
Study Design: Primary research studies, including observational designs (prospective and retrospective cohorts, nested case-control, and cross-sectional) and interventional designs, were eligible. Secondary research, including systematic reviews, meta-analyses, and health economic simulation models, was also included to provide a comprehensive mapping of available evidence.
Population: Adults or adolescents with a confirmed diagnosis of any type of diabetes mellitus (T1DM, T2DM, or mixed populations).
Exposure: Smoking or tobacco use, encompassing current, former, or lifetime exposure.
Outcome: Hypoglycemia of any definition, including severe, symptomatic, CGM-detected, or biochemical episodes.
Language and Availability: Only English-language articles with accessible full-text were included in the final synthesis.
Data Extraction and Synthesis
Data were extracted using a standardized charting form, capturing study characteristics (author, year, country), population details, diabetes type, smoking exposure metrics, hypoglycemia definitions, effect sizes (hazard ratios, odds ratios, incidence rate ratios), and strength of evidence. Given the methodological heterogeneity across exposure measurements, outcome definitions, and analytic approaches, quantitative meta-analysis was not appropriate for the majority of outcomes. Findings were therefore synthesized narratively according to outcome severity and methodological robustness. A GRADE-based certainty of evidence assessment was applied for the key outcomes.
Overview of Study Characteristics
Nineteen studies were included, collectively encompassing over 4.5 million individuals with T1DM, T2DM, or mixed diabetes populations (Table 1). Study designs were heterogeneous, including nationwide prospective cohorts, registry-based analyses, nested case–control studies, cross-sectional investigations, systematic reviews with meta-analyses, and one simulation model. Smoking exposure was primarily self-reported, although several large administrative cohorts utilized health examinations or registry-linked data. Hypoglycemia outcomes ranged from medically attended severe hypoglycemia to self-reported non-severe episodes, impaired awareness of hypoglycemia (IAH), mortality, and markers of glycemic instability measured by continuous glucose monitoring (CGM).
| No. | Study | Design / Data Source | Population | Smoking Exposure | Hypoglycemia Outcome | Main Finding / Effect Estimate | Direct Analysis | Evidence Category | Key Limitations |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Ahlen et al., 2016 [14] | Nationwide cohort, Sweden | 33,915 T1DM + 169,249 matched controls | Current smoking | Death from hypoglycemia or DKA in adults <50> | Smoking: HR 2.86 (95% CI 1.57–5.22) for hypoglycemia/DKA death | Yes (combined outcome) | T1DM mortality signal | Hypoglycemia and DKA combined; residual confounding |
| 2 | Hogendorf et al., 2017 [15] | Cross-sectional; ESPAD questionnaire | 209 adolescents with T1DM; 12,114 controls | Lifetime and recent cigarette use | Severe hypoglycemia and DKA | Lifetime smoking associated with higher SH incidence and poorer metabolic control (HbA1c ≥8%) | Yes | T1DM adolescent evidence | Small T1DM sample; self-reported HbA1c; limited statistical power |
| 3 | Han et al., 2018 [16] | Nationwide population-based cohort; Korea NHID | 1,676,885 adults with T2DM | Current smoking | Severe hypoglycemia (ICD-10 coded) | Current smoking: HR 1.17 (95% CI 1.08–1.26) | Yes | Core SH evidence (T2DM) | No HbA1c data; medically attended events only |
| 4 | Jendle et al., 2018 [17] | Health economic simulation (IQVIA CORE Diabetes Model) | 1,000 simulated T1DM patients | Smoking subgroup (modelled) | Modelled long-term hypoglycemia outcomes | No direct empirical smoking–hypoglycemia effect estimated | No | Very low-certainty simulation | Simulation only; not empirical; derived from model assumptions |
| 5 | Shah et al., 2018 [18] | T1D Exchange registry; cross-sectional | 9,481 adults with T1DM | Current smoking prevalence | Acute complications; self-care variables | Higher smoking prevalence in men; smoking–SH association not directly analyzed | No | Contextual T1DM evidence | Cross-sectional; smoking not modelled as SH predictor |
| 6 | Cai et al., 2019 [19] | Prospective nationwide cohort; China | 5,770 newly diagnosed T2DM | Current smoking | Metabolic target failure; hypoglycemia (secondary) | Smoking associated with metabolic failure; hypoglycemia not directly linked to smoking | Indirect | Metabolic control pathway evidence | Short follow-up (12 months); not designed for smoking–hypoglycemia analysis |
| 7 | Yun et al., 2019 [20] | Nationwide population-based cohort; Korea | 1.3+ million T2DM adults | Smoking in subgroup analyses | Severe hypoglycemia requiring medical care | Low BMI strongly associated with SH; smoking modified risk patterns (contextual) | Indirect/contextual | Contextual risk-factor evidence | Smoking not the primary exposure; administrative data only |
| 8 | van Mark et al., 2020 [21] | Registry-based cross-sectional; DPV/DIVE registries | 396,719 older adults with T2DM | Smoking prevalence by age group | SH across age groups | SH more frequent in oldest-old; smoking–SH association not directly modelled | No | Contextual elderly T2DM evidence | Smoking not tested as SH predictor |
| 9 | Zaccardi et al., 2020 [22] | UK primary care observational cohort | 74,610 adults with T2DM | Current smoking (baseline covariate) | Severe hypoglycemia and cause-specific mortality | SH predicted higher mortality; smoking not tested as SH predictor | No | Contextual mortality evidence | Smoking not primary exposure; residual confounding |
| 10 | Jensen et al., 2021 [23] | Randomized trial CGM subanalysis (Onset 5) | 49 smokers and 320 non-smokers; T1DM | Daily smoking | CGM-detected hypoglycemia; time in range; SH rate | Smokers: nearly doubled SH rate; higher glycemic variability; increased time in very low glucose | Yes | Objective CGM-based evidence | Small smoker subgroup; limited SH power; European/North American population only |
| 11 | Agrawal et al., 2022 [24] | Cross-sectional analysis; Poland | 300 T1DM or T2DM patients | Smoking status | Self-reported hypoglycemia | Smoking correlated with increased hypoglycemia risk alongside alcohol use and low BMI | Yes (lower certainty) | Supportive cross-sectional evidence | Small sample; recall bias; cross-sectional design |
| 12 | Al-Ma'aitah et al., 2022 [25] | Systematic review and meta-analysis; MENA region | 54 studies; 41,079 T2DM adults | Current smoking | Inadequate glycemic control | Smoking associated with poor glycemic control: OR 1.26 (95% CI 1.05–1.52) | Indirect | Metabolic pathway evidence | High heterogeneity; mostly cross-sectional; hypoglycemia not direct outcome |
| 13 | Galindo et al., 2022 [26] | Retrospective population-based cohort; USRDS | 521,789 U.S. adults with diabetes and ESKD | Tobacco use (self-reported/registry) | Severe hypoglycemic crisis (ED/hospitalization) | Tobacco use: IRR 1.35 (95% CI 1.28–1.43) | Yes | Strong population-based evidence (ESKD) | Diabetes type not differentiated; administrative coding |
| 14 | Hassounah et al., 2022 [27] | Cross-sectional questionnaire study; Saudi Arabia | 242 T1DM patients | Current smoking | Impaired awareness of hypoglycemia (IAH) | Smoking not significantly associated with IAH (p = 0.166) | No significant association | Low-certainty IAH evidence | Small sample; single center; self-reported exposure and outcome |
| 15 | Settles et al., 2022 [28] | Nested case-control study; U.S. IQVIA claims data | 3,153 case-control pairs; insulin-treated T2DM | Current or history of smoking | SH requiring emergency care | Smoking independently associated with SH: OR 1.28 (95% CI 1.08–1.52) | Yes | Core SH evidence | Emergency-care events only; pharmacy claims may not reflect actual intake |
| 16 | Yun et al., 2022 [29] | Nationwide longitudinal cohort; Korea | 1,490,233 T2DM adults | Current smoking and lifestyle composite | Severe hypoglycemia requiring medical care | Current smoking: HR 1.28 (95% CI 1.23–1.34); lifestyle dose-response up to HR 1.81 | Yes | Very strong population-based evidence | Lifestyle self-reported; HbA1c and medication dose unavailable |
| 17 | Naser et al., 2025 [30] | Retrospective cross-sectional; Saudi Arabia hospital | 396 hospitalized patients with hypoglycemia | Ex-smoker/current smoker status | Hospitalization cost, length of stay, ICU admission | Ex-smokers: 4.4-fold higher hospitalization costs; smoking as incident risk factor not analyzed | No/indirect | Health economic burden evidence | Single-center; retrospective; cost/burden outcome not incident hypoglycemia risk |
| 18 | Veryanti et al., 2025 [31] | Cross-sectional outpatient study; Jakarta, Indonesia | 501 T2DM outpatients; five hospitals | Current smoking vs. non-smoking | Any self-reported hypoglycemia (previous 3 months) | Non-smoking associated with higher reported hypoglycemia (OR 2.2; 95% CI 1.3–3.6); likely confounded | Yes (inconsistent result) | Low-certainty/conflicting evidence | Self-reported; cross-sectional; probable confounding by insulin use and treatment intensity |
| 19 | Zhang et al., 2025 [32] | Systematic review and meta-analysis | 31 studies; 54,634 T1DM adults | Current smoking | Overall hypoglycemia risk in T1DM | Smoking: pooled OR 1.17 (95% CI 1.07–1.28) | Yes | Core T1DM meta-analytic evidence | Heterogeneity in hypoglycemia definitions; many cross-sectional studies included |
Table 1: presents the full evidence base, organized chronologically. Table 2 provides a GRADE summary of evidence by outcome category.
Abbreviations: T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus; SH, severe hypoglycemia; IAH, impaired awareness of hypoglycemia; HR, hazard ratio; OR, odds ratio; IRR, incidence rate ratio; CI, confidence interval; CGM, continuous glucose monitoring; ESKD, end-stage kidney disease; DKA, diabetic ketoacidosis; ED, emergency department; MENA, Middle East and North Africa; USRDS, United States Renal Data System; NHID, National Health Insurance Database.
Severe Hypoglycemia Requiring Medical Attention
The most consistent and methodologically robust evidence was derived from large population-based cohort studies examining medically attended SH. Han et al. [16] utilized a nationwide South Korean cohort of over 1.6 million adults with T2DM and demonstrated that current smoking was independently associated with an increased risk of SH (HR 1.17; 95% CI: 1.08–1.26), after adjustment for multiple confounders including age, sex, body mass index, comorbidities, and pharmacotherapy. Yun et al. [29] substantially extended this evidence in a cohort of 1,490,233 Korean adults with T2DM, confirming an adjusted HR of 1.28 (95% CI: 1.23–1.34) for current smokers. Critically, this study further demonstrated a dose-response relationship: the co-occurrence of smoking with other unhealthy lifestyle behaviors (heavy alcohol consumption, physical inactivity) was associated with an HR of 1.81, establishing a lifestyle risk-gradient model for SH prevention.
In a U.S. population-based cohort of 521,789 adults with diabetes and end-stage kidney disease (ESKD), Galindo et al. [26] reported that tobacco use was independently associated with a significantly higher rate of severe hypoglycemic crises requiring emergency department visits or hospitalization (IRR 1.35; 95% CI: 1.28–1.43). Settles et al. [28], using a nested case–control design of insulin-treated T2DM patients, identified smoking as a previously underrecognized risk factor for medically attended SH (OR 1.28; 95% CI: 1.08–1.52), independent of established predictors including age, comorbidities, and insulin type.
Evidence in Type 1 Diabetes
Dedicated T1DM evidence was provided by several complementary studies. Ahlen et al. [14], in a nationwide Swedish cohort of 33,915 individuals with T1DM, found that smoking was a significant independent predictor of death attributed to hypoglycemia or diabetic ketoacidosis in adults younger than 50 years (HR 2.86; 95% CI: 1.57–5.22). While the combined outcome definition limits precise attribution to hypoglycemia alone, the magnitude of this effect was clinically substantial. Hogendorf et al. [15] reported, in a cross-sectional study of Polish adolescents with T1DM, that lifetime smoking was associated with higher SH incidence and worse metabolic control compared with non-smokers.
The most methodologically rigorous T1DM-specific evidence was provided by a recent meta-analysis by Zhang et al. [32], which synthesized data from 31 studies comprising 54,634 adults with T1DM and confirmed smoking as an independent risk factor for hypoglycemia (pooled OR 1.17; 95% CI: 1.07–1.28). This finding, derived through standardized pooled analysis, confirms the biological plausibility and statistical robustness of the smoking–hypoglycemia association in T1DM populations.
CGM-Detected Hypoglycemia and Glycemic Variability
Jensen et al. [23] provided objective, sensor-derived evidence from a sub-analysis of a randomized trial (Novo Nordisk Onset 5). Among 49 smokers and 320 non-smokers with T1DM receiving continuous subcutaneous insulin infusion, smokers exhibited a 4.7-fold increased risk of not achieving glycemic targets (95% CI: 1.5–15.4), increased time in hyperglycemia, decreased time in range, and a nearly two-fold higher rate of SH. CGM median profiles also revealed an elevated risk of morning hypoglycemia in smokers, suggesting a temporal pattern potentially related to nocturnal nicotine withdrawal effects on counterregulatory hormone release.
Non-Severe and Self-Reported Hypoglycemia
Evidence for non-severe and self-reported hypoglycemia was heterogeneous and of lower certainty. Agrawal et al. [24] demonstrated a positive correlation between smoking and hypoglycemia in a cross-sectional analysis of 300 Polish patients with T1DM or T2DM; however, the small sample size and cross-sectional design limit causal inference. Notably, Veryanti et al. [31] reported a paradoxical inverse association, with non-smoking independently associated with higher self-reported hypoglycemia risk (OR 2.2; 95% CI: 1.3–3.6) in a cohort of Indonesian outpatients. This result is likely confounded by differences in treatment intensity, with non-smoking patients potentially receiving more aggressive glucose-lowering pharmacotherapy, and illustrates the methodological challenges inherent to cross-sectional self-report designs.
GRADE Evidence Summary
| Outcome | No. Studies | Key Studies | Participants | Effect Estimate | Certainty (GRADE) | Key Comments |
|---|---|---|---|---|---|---|
| Severe Hypoglycemia (Medical/ER) | 7 | Han 2018 [16]; Galindo 2022 [26]; Settles 2022 [28]; Yun 2022 [29]; Yun 2019 [20]; van Mark 2020 [21]; Zaccardi 2020 [22] | >4.5 million | HR/OR 1.17–1.35 | HIGH | Consistent risk across large cohorts; dose-response relationship observed |
| Severe Hypoglycemia (T1DM Adults) | 3 | Ahlen 2016 [14]; Hogendorf 2017 [15]; Zhang 2025 meta-analysis [32] | ~88,000 | OR 1.17 (95% CI 1.07–1.28) | HIGH | Meta-analysis confirmed smoking as independent T1DM risk factor |
| CGM-Detected Hypoglycemia | 1 | Jensen 2021 [23] | 369 | ~2-fold increase | MODERATE | Objective CGM-based evidence; strengthens biological plausibility; small smoker subgroup |
| Hypoglycemia-Related Mortality (T1DM) | 1 | Ahlen 2016 [14] | 33,915 | HR 2.86 (95% CI 1.57–5.22) | MODERATE | Outcome combined hypoglycemia + DKA; strong clinical signal |
| Metabolic Instability (HbA1c ≥7%) | 1 | Al-Ma'aitah 2022 [25] | 41,079 | OR 1.26 (95% CI 1.05–1.52) | MODERATE | Poor glycemic control may predispose to hypoglycemia through indirect pathway |
| Non-Severe / Self-Reported | 4 | Agrawal 2022 [24]; Hogendorf 2017 [15]; Veryanti 2025 [31]; Cai 2019 [19] | ~6,800 | OR 0.45–2.56 | LOW | Heterogeneous definitions; recall bias; cross-sectional designs |
| Impaired Awareness (IAH) | 1 | Hassounah 2022 [27] | 242 | p = 0.166 (NS) | LOW | Self-reported outcomes; small sample; imprecision noted |
| Modelled Risk (Simulation) | 1 | Jendle 2018 [17] | 1,000 (simulated) | No direct effect estimated | VERY LOW | Indirect modeling; no empirical data on smoking-hypoglycemia link |
Table 2: presents the GRADE summary of evidence across the principal outcome categories. Consistent, large-effect-size evidence from multiple population-based cohorts supports high certainty for medically attended SH in both T1DM and T2DM, while CGM-based evidence was rated moderate certainty due to limited sample sizes in the smoker subgroup. Evidence for non-severe and self-reported hypoglycemia was rated low certainty, reflecting methodological heterogeneity and risk of bias.
This scoping review synthesizes evidence from 19 studies encompassing over 4.5 million individuals to examine the association between smoking and hypoglycemia in diabetes. The findings demonstrate that smoking is consistently associated with an increased risk of SH requiring medical attention, with effect estimates ranging from HR/OR 1.17 to 1.35 across large-scale population-based cohorts. This association was observed in both T1DM and T2DM populations, with high-certainty evidence supporting smoking as an independent and modifiable risk factor for clinically attended SH. In contrast, evidence for non-severe, self-reported, and CGM-detected hypoglycemia remained heterogeneous and of lower certainty.
Several interacting biological and behavioral mechanisms plausibly underlie the observed association. Nicotine acutely stimulates catecholamine release, promoting transient hyperglycemia, but chronic smoking-induced insulin resistance may lead to compensatory increases in exogenous insulin dosing, elevating the background risk of hypoglycemia [9, 10]. Smoking also impairs sympatho-adrenal counterregulatory responses to hypoglycemia, potentially blunting glucagon secretion and epinephrine-mediated glucose recovery [14, 23]. Furthermore, smoking-associated irregular meal patterns, increased alcohol co-use, psychological distress, and lower adherence to self-management behaviors create a behavioral risk milieu that compounds the pharmacological risk [24, 29]. The lifestyle composite analysis by Yun et al. [29] exemplifies this interaction, with an escalating HR from 1.28 for smoking alone to 1.81 when combined with heavy drinking and physical inactivity.
The findings of this review carry several important clinical implications. First, smoking should be formally recognized as an independent and modifiable risk factor for SH and routinely assessed within comprehensive diabetes care frameworks. Current clinical guidelines, while emphasizing smoking cessation for cardiovascular and microvascular risk reduction [33], rarely highlight hypoglycemia prevention as a specific clinical indication. Incorporating hypoglycemia risk as an additional benefit of cessation may enhance patient motivation and prioritize cessation efforts in clinical encounters.
Second, patients with diabetes who smoke may benefit from intensified hypoglycemia prevention strategies, including structured education on hypoglycemia recognition and management, more frequent glucose monitoring, and preferential use of glucose-lowering agents with lower intrinsic hypoglycemia risk, such as GLP-1 receptor agonists or SGLT2 inhibitors, where clinically appropriate [34, 35]. For insulin-treated patients, proactive review of insulin regimens, dose adjustments, and integration of CGM technology may further mitigate smoking-related hypoglycemia risk, as supported by the CGM-based evidence of Jensen et al. [23].
Third, smoking cessation interventions should be proactively offered and integrated into routine diabetes care pathways. Evidence-based cessation strategies, including pharmacotherapy with nicotine replacement, varenicline, and bupropion, behavioral counseling, and digital health interventions, have demonstrated efficacy in the general population [36, 37]. Importantly, clinicians should anticipate and address challenges specific to diabetes, including transient glycemic variability during cessation, weight gain, and psychological distress [38, 39]. Cessation benefits for diabetes patients extend well beyond hypoglycemia risk reduction, encompassing clinically meaningful reductions in cardiovascular events, cancer risk, microvascular complications, and all-cause mortality [13, 40].
Finally, the health economic burden of SH is substantial. Naser et al. [30] demonstrated that ex-smokers hospitalized for hypoglycemia incurred 4.4-fold higher costs than non-smokers, underscoring the economic case for proactive smoking cessation as an acute safety and cost-reduction strategy within diabetes care systems.
Strengths and Limitations
The strengths of this review include the systematic search strategy, adherence to PRISMA-ScR guidelines, inclusion of diverse study designs from multiple healthcare systems, synthesis of data from over 4.5 million participants, and application of GRADE criteria to assess certainty of evidence. The inclusion of CGM-based and meta-analytic evidence further strengthens the evidence mapping.
Several limitations warrant acknowledgment. First, restriction to English-language publications may have introduced language bias, potentially excluding relevant studies from non-English-speaking countries. Second, the scoping review methodology prioritizes breadth over depth and does not include a formal risk of bias assessment; a systematic review with risk of bias evaluation would be warranted for primary outcomes. Third, heterogeneity in hypoglycemia definitions across studies — ranging from ICD-coded hospitalizations to self-reported symptomatic episodes to CGM-detected glucose values below 70 mg/dL — complicates direct comparisons. Adoption of standardized definitions, such as those proposed by the International Hypoglycemia Study Group [41], would facilitate future synthesis. Fourth, smoking exposure was predominantly self-reported across studies, introducing social desirability and misclassification bias; biochemical validation (e.g., cotinine measurement) was rarely employed. Fifth, as the majority of included studies were observational, causal inference is limited by residual confounding and potential reverse causation.
This scoping review provides high-certainty evidence that current smoking is associated with a consistent and clinically significant increase in the risk of severe hypoglycemia in individuals with T1DM and T2DM. The consistency of findings across large population-based cohorts, the demonstration of dose-response relationships, and the biological plausibility of multiple mechanistic pathways collectively support smoking as an independent and modifiable risk factor for severe hypoglycemic events requiring medical attention. Evidence for non-severe hypoglycemia, impaired awareness, and CGM-detected hypoglycemia remains more limited and of lower certainty.
From a clinical perspective, these findings underscore the importance of integrating smoking cessation into comprehensive diabetes care as a pragmatic acute safety strategy to reduce hypoglycemia risk, complementing established interventions such as patient education, intensified glucose monitoring, and pharmacotherapy optimization. From a public health perspective, population-level smoking cessation programs and policy-level tobacco control measures may yield meaningful reductions in hypoglycemia-related morbidity, mortality, and healthcare expenditure in individuals with diabetes. Future interventional research incorporating hypoglycemia as a primary endpoint in diabetes-specific smoking cessation trials is needed to formally quantify the clinical and economic benefits of cessation for hypoglycemia prevention.
Declarations
Authors’ Contributions
MMB conceived the study, designed the search strategy, conducted the literature search, performed data extraction and synthesis, and drafted the manuscript. IS contributed to the literature search, data extraction, and critical revision of the manuscript for important intellectual content. MAB provided clinical expertise, supervised the conceptual framework, critically revised the manuscript, and approved the final version for submission. All authors read and approved the final manuscript.
Conflict of Interest
The authors declare no competing interests.
Funding
This research received no external funding.
Ethical Compliance
All procedures performed in studies involving human participants were conducted in accordance with the ethical standards of the relevant institutional and/or national research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. As this is a scoping review of published literature and no primary data were collected, additional ethical approval was not required.
Data Access Statement
No primary data were generated or analyzed during this scoping review. All data supporting the conclusions of this review are drawn from the published literature included in the reference list.
AI Disclosure
During the preparation of this manuscript, the authors used Google Gemini (Google LLC, Mountain View, CA, USA) and Notebook LM (Google LLC) as AI-assisted tools to support initial literature organization, thematic structuring, and language refinement. All AI-generated suggestions were critically reviewed, verified against the primary literature, and substantially revised by the authors. AI tools were not used for study design, literature search execution, data extraction, statistical analysis, or interpretation of results. The authors take full responsibility for the integrity and accuracy of all content in this publication.
Acknowledgments
The authors thank the research librarians at Gaziosmanpasa Training and Research Hospital for their assistance with database access. No external funding was received for this study.
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I Appreciate the Opportunity to Share my Experience with the Journal of Clinical Research and Reports. The peer review process was timely and constructive, and the feedback provided helped improve the quality of our manuscript. The editorial office was professional, responsive, and supportive throughout the process, ensuring smooth communication and efficient handling of the submission. Overall, it was a positive experience collaborating with your team.
Dear Mercy Grace, Editorial Coordinator of Obstetrics Gynecology and Reproductive Sciences, We would like to express our gratitude for your help at all stages of publishing and editing the article. The editors of the magazine answer all the necessary questions and help at every stage. We will definitely continue to cooperate and publish other works in the Obstetrics Gynecology and Reproductive Sciences! Best wishes from, Alla Konstantinovna Politova,
Dear Maria Emerson, Editorial Coordinator of International Journal of Clinical Case Reports and Reviews, What distinguishes International Journal of Clinical Case Report and Review is not only the scientific rigor of its publications, but the intellectual climate in which research is evaluated. The submission process is refreshingly free of unnecessary formal barriers and bureaucratic rituals that often complicate academic publishing without adding real value. The peer-review system is demanding yet constructive, guided by genuine scientific dialogue rather than hierarchical or authoritarian attitudes. Reviewers act as collaborators in improving the manuscript, not as gatekeepers imposing arbitrary standards. This journal offers a rare balance: high methodological standards combined with a respectful, transparent, and supportive editorial approach. In an era where publishing can feel more burdensome than research itself, this platform restores the original purpose of peer review — to refine ideas, not to obstruct them Prof. Perlat Kapisyzi, FCCP PULMONOLOGIST AND THORACIC IMAGING.
Dear Reader: We have published several articles in the Auctores Publishing, LLC, journal, Clinical Medical Reviews and Reports in recent years (CMRR). This is an ‘open access’ journal and the following are our observations. From the initial invitation to submit an article, to the final edits of galley proofs, we have found CMRR personnel to be professional, responsive, rapid and thorough. This entire process begins with Catherine Mitchell, Editorial Coordinator. She is simply outstanding, and, I believe, unparalleled in her capacity. I cannot imagine a more responsive and dedicated Editorial Coordinator. As I read the dates and timing of her correspondence with us, it seems that she never sleeps. I hope Auctores Publishing, LLC, appreciates her efforts as much as these authors do. Thank you to Auctores Publishing, LLC, to the Editorial Staff/Board, and to Catherine Mitchell from a grateful author(s).
Dear Maria Emerson, Editorial Coordinator of - Journal of Clinical Research and Reports. ''I am pleased to provide this testimonial following the publication of our recent case report in this journal. The peer review process was rigorous, constructive, thorough, and conducted in a timely manner. The reviewers’ comments were thoughtful, detailed, and highly constructive, contributing substantially to the refinement, clarity, and scientific robustness of our manuscript. The process was conducted with professionalism and academic integrity throughout. The support provided by the editorial office was exemplary. Communication was consistently prompt, clear, and courteous at all stages of the submission and publication process. The editorial team demonstrated a high level of organization and responsiveness, ensuring that all queries were addressed efficiently and that the process remained transparent and well-coordinated. The overall quality of the journal is reflected in its strong editorial standards, commitment to scientific excellence, and dedication to publishing clinically meaningful research. It has been a privilege to publish our work in this journal, and we would welcome the opportunity to contribute further in the future.'' Best wishes from, Dr. Efstratios Trogkanis, Cardiologist.
Dear Grace Pierce, Editorial Coordinator of the journal IJCCR, I had a very positive experience with Auctores - Journal throughout the publication process. The Editorial Team was highly responsive, professional, and supportive at every stage. I would like to extend my sincere thanks to the Editor: Grace Pierce, for her guidance and assistance. The peer-review process was smooth and constructive, helping improve the quality of my work. I would gladly recommend Auctores Journal to fellow researchers and authors. Dr. SABITA SINHA, Medical Oncologist, MD (Electro Homeopathy).
Dear Mayra Duenas, Editorial Coordinator of the journal IJCCR, I write here a little on my experience as an author submitting to the International Journal of Clinical Case Reports and Reviews (IJCCR). This was my first submission to IJCCR and my manuscript was inherently an outsider’s effort. It attempted to broadly identify and then make some sense of life’s under-appreciated mysteries. I initially had responded to a request for possible submissions. I then contacted IJCCR with a tentative topic for a manuscript. They quickly got back with an approval for the submission, but with a particular requirement that it be medically relevant. I then put together a manuscript and submitted it. After the usual back-and-forth over forms and formality, the manuscript was sent off for reviews. Within 2 weeks I got back 4 reviews which were both helpful and also surprising. Surprising in that the topic was somewhat foreign to medical literature. My subsequent updates in response to the reviewer comments went smoothly and in short order I had a series of proofs to evaluate. All in all, the whole publication process seemed outstanding. It was both helpful in terms of the paper’s content and also in terms of its efficient and friendly communications. Thank you all very much. Sincerely, Ted Christopher, Rochester, NY.
International Journal of Clinical Case Reports and Reviews is a high quality journal that has a clear and concise submission process. The peer review process was comprehensive and constructive. Support from the editorial office was excellent, since the administrative staff were responsive. The journal provides a fast and timely publication timeline.
Dear Cecilia Lilly, Editorial Coordinator, Endocrinology and Disorders, Thank you so much for your quick response regarding reviewing and all process till publishing our manuscript entitled: Prevalence of Pre-Diabetes and its Associated Risk Factors Among Nile College Students, Sudan. Best regards, Dr Mamoun Magzoub.
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. I am really grateful for the peers review; their feedback gave me the opportunity to reflect on the message and impact of my work and to ameliorate the article. The editors did a great job in addition by encouraging me to continue with the process of publishing.
Dear Mayra Duenas, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews Herewith I confirm an optimal peer review process and a great support of the editorial office of the present journal
Dear Maria Emerson, Editorial Coordinator of ‘International Journal of Clinical Case Reports and Reviews’, I appreciate the opportunity to publish my article with your journal. The editorial office provided clear communication during the submission and review process, and I found the overall experience professional and constructive. Best regards, Elena Salvatore.
Dear Editorial Team, Journal-Clinical Cardiology and Cardiovascular Interventions, “Publishing my article with Clinical Cardiology and Cardiovascular Interventions has been a highly positive experience. The peer-review process was rigorous yet supportive, offering valuable feedback that strengthened my work. The editorial team demonstrated exceptional professionalism, prompt communication, and a genuine commitment to maintaining the highest scientific standards. I am very pleased with the publication quality and proud to be associated with such a reputable journal.” Warm regards, Dr. Mahmoud Kamal Moustafa Ahmed
Dear Editorial Team, Clinical Cardiology and Cardiovascular Interventions. It was truly a rewarding experience to work with the journal “Clinical Cardiology and Cardiovascular Interventions”. The peer review process was insightful and encouraging, helping us refine our work to a higher standard. The editorial office offered exceptional support with prompt and thoughtful communication. I highly value the journal’s role in promoting scientific advancement and am honored to be part of it. Best regards, Meng-Jou Lee, MD, Department of Anesthesiology, National Taiwan University Hospital.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
