AUCTORES
Globalize your Research
Short Communication | DOI: https://doi.org/10.31579/2641-8975/006
*Corresponding Author: Louise Tom, Department of Endocrinology and Diabetes. Iran.
Citation: Louise Tom, Sheryl O. Hughes, Tom Baranowski, Thiazide diuretics such as HCTZ more often cause hyperglycemia (or) chlorthalidone than other diuretics. J Diabetes and Islet Biology. Doi:10.31579/2641-8975/006
Copyright: © 2018 Louise Tom.This is an open-access article distributed under the terms of The Creative Commons Attribution License, whichpermits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 06 September 2018 | Accepted: 13 September 2018 | Published: 26 September 2018
Keywords: hyperglycemia, diuretics, diabetes
Background: Antihypertensive drugs including thiazide diuretics, beta blockers (BB), calcium channel blockers (CCB), reninangiotensin inhibitors or vasodilators produce elevated blood glucose (hyperglycemia) (>70-99 mg/dL). Hyperglycemia is more common and severe with thiazide diuretics than with BB, CCB, ACEI or ARB drugs. Questions have been raised about the mechanism and risk of drug-induced hyperglycemia.
Method: We present here four patients treated with diuretics who developed hyperglycemia - fasting blood glucose (FBG) > 126 mg/ dL (7 mmol/L) diagnostic of diabetes. Three patients had hypertension and one, congestive heart failure (CHF). Three patients had no diabetes, one gave 8 to 10 year history of diabetes. One patient received no diuretic therapy and his glucose level was normal with insulin and oral hypoglycemic agent treatment. Subsequently, he became hypertensive and was treated with a thiazide diuretic but no antidiabetic agents. He then developed new-onset diabetes.
Results: All patients showed hyperglycemia above FBG criteria for diabetes. 2-hour postprandial blood glucose (2hPPG) was not diagnostic of diabetes in three patients. Two patients were prescribed antidiabetic therapy which was stopped with no worsening of hyperglycemia although diuretic therapy continued. In two patients diuretic was discontinued. Hyperglycemia abated in one, while in the other, hyperglycemia worsened requiring Glargine insulin.
Conclusion: Hyperglycemia is common in patients with hypertension or CHF treated with a thiazide diuretic alone or in combination with other diuretics. Although by definition the term new-onset diabetes may be used to connote hyperglycemia, in reality diabetes induced by diuretics is not diabetes as 2hPPG does not usually exceed 200 mg/dL (11.1 mmol/L), and patients show no evidence of any vascular complications. It may be more appropriate to define elevated glucose associated with diuretic "hyperglycemia" rather than new-onset diabetes. The real issue is that use of thiazide diuretics is imperative in blood pressure control especially in resistant hypertension. Even with new-onset diabetes, thiazide diuretics are commonly found to be safe, reducing risk of stroke, heart attack, and renal failure characteristic of uncontrolled hypertension. Therefore, risks of new-onset diabetes, induced by diuretic therapy, will be difficult to ascertain because of hypertension for which thiazide diuretic is widely used.
Diabetes is a major cardiovascular risk factor, but drug-induced new-onset diabetes may not have clinical significance and should not be a major determinant when choosing a treatment for hypertension if the medication is necessary to reduce blood pressure[1]. A study found no difference in the number of patients who developed diabetes with different antihypertensive drugs, including diuretics and beta blockers as shown in Figure 1 [2].
Figure 1 demonstrates that all antihypertensive drugs may produce hyperglycemia although the risk of hyperglycemia varies. In the ALLHAT study, chlorthalidonetreated patients achieved the same primary end point results – fatal and nonfatal infarcts – as amlodipine or Lisinopril treated subjects despite the fact that an increase in serum glucose of 3 to 5 mg/dL and new-onset diabetes was more frequent in the diuretic-based treatment groups. The investigators concluded that "there was no advantage to the use of Lisinopril compared with a diuretic despite the difference in new-onset diabetes". The use of alpha blockers does not increase serum glucose; but in the ALLHAT study, cardiovascular events were more frequent with an alpha blocker compared with a diuretic [3].
A group of investigators from Italy studied the outcome of new-onset diabetes in treated hypertensive subjects compared to those with previously known diabetes. They found that subjects in whom diabetes developed were exposed to diuretics, calcium channel blockers, and angiotensin converting enzyme inhibitors (ACEI) more frequently than those in whom diabetes did not develop as shown in Figure 2 [4].
The purpose of this communication is to present a few patients who were diagnosed to have developed diabetes during treatment of hypertension who were then placed on antidiabetic therapy. Withdrawal of antidiabetic therapy and treatment with potassium supplements did not result in worsening of hyperglycemia or appearance of overt diabetes.
In addition, a patient is presented to demonstrate that diureticinduced hyperglycemia may occasionally lead to overt diabetes requiring insulin therapy.
Overt diabetes is defined by a 2-hour post-load plasma glucose (2 hPPG) concentration of ≥ 200 mg/dL (11.1 mmol/L) [5]. Hyperglycemia or new-onset diabetes has not been clearly defined. However, in this study hyperglycemia is defined by FBG above 126 mg/dL (7 mmol/L).
Patient #1 – A 67 year old African American male was referred by a primary care physician and seen by the authors (AKM) in the office in November of 2011 for renal insufficiency. He gave history of hypertension for a long time and diabetes for nine months. He is a farm worker and is very active. Daily medication at the time of first visit consisted of hydrochlorothiazide (HCTZ) 25 mg, glimepiride 2 mg, Lisinopril 40 mg, pravastatin 80 mg, amlodipine 10 mg, metoprolol 100 mg, and allopurinol 300 mg all PO daily. During this visit he had a pulse of 66 beats/ min and sitting and upright blood pressures (BP) were 130/90 mmHg. Otherwise his physical examination was normal. The only available laboratory data at this visit was decreased estimated glomerular filtration rate (eGFR) of 42 mL/min (N =>60 ml/min). Action at this office visit included discontinuation of Lisinopril, increase of amlodipine to 10 mg a.m. and 5 mg p.m. to improve BP control, and decrease of allopurinol 150 mg (due to decreased kidney function), and decrease of pravastatin to 40 mg PO daily. Fasting and 2-h basic metabolic panel (BMP), glycosylated hemoglobin (HbA1c) and serum insulin levels were ordered. At his next visit, two weeks later, FBG was 102 mg/dL and 2 hPPG was 139 mg/dL. Both of these levels were normal. Serum creatinine (mg/dL) and eGFR (ml/ min) for the corresponding periods were 1.73/42 and 1.66/44 respectively. The 2hPP serum insulin level was 126.5 ulU/L. At this time, he was advised to discontinue glimepiride, switch HCTZ to chlorthalidone 25 mg daily, increase amlodipine to 10 mg twice daily, and potassium chloride 20 mEq daily was added. At his third visit, six weeks later, his glucose levels for both FBG and 2 hPPG were increased. He returned to the office in late March of 2012 with a laboratory done March 1, 2012. He is no longer taking glimepiride but taking thiazide diuretic chlorthalidone 25 mg/day to keep hypertension under control. His sitting and upright BP were 120/80 mmHg. FBG and 2 hPPG decreased to 130 mg/dL and 152 mg/dL, respectively' compared to those in the previous visit even though he was no longer taking the glimepiride. His fasting insulin was normal (16.7 μIU/ml) and his serum potassium was low (3.4 mmol/L) in both periods due to chlorthalidone. Thus potassium intake was increased to 20 mEq twice daily and the patient was advised to increase dietary potassium. Thus here is a patient who went to a physician for treatment of hypertension. He was treated with a thiazide diuretic, beta blocker, calcium channel blocker and ACEI drugs. All of these antihypertensive drugs have been documented to produce hyperglycemia (Figure 1) [1,2]. He developed hyperglycemia with a random glucose level of 180 mg/dL (10 mmol/L) and HbA1c 6.2% noted in June of 2011. Thus he was labeled to have developed Type 2 diabetes mellitus (DM) and placed on glimepiride, an oral hypoglycemic agent. Perhaps the primary care physician did not know that it is common to find hyperglycemia when a patient is treated with a thiazide diuretic, and glucose level is often reduced with correction of serum potassium. Therefore by definition, he does not have diabetes (2 hPPG > 200 mg/dL) [5]. BP is under control and kidney function is improving. This slightly elevated glucose is clearly due to the thiazide diuretic, chlorthalidone, as evidenced by concomitant hypokalemia. His major risk factors were uncontrolled hypertension which is now under control, and decreased kidney function which is now improving. He is asymptomatic and active.
Patient #2 – A 58 year old white male, wheelchair bound, a self-referral to AKM in November of 2011, gave an 8 to 10 ten year history of diabetes. He was treated with metformin 500 mg PO twice daily, glipizide 5 mg PO daily, enalapril 10 mg PO daily, indomethacin 50 mg PO every 8 hours for gout, and Lipitor 10 mg PO daily. The patient was also diagnosed with atrial fibrillation which was treated with digoxin 0.125 mg PO daily and warfarin 2 mg PO daily. Two months prior to the first office visit with this author, the patient was admitted to a local hospital with acute renal failure where oral hypoglycemic agents were discontinued and he was started on insulin. At the time of the first office visit, the patient was receiving insulin detemir (Levemir ®) 20 U subcutaneously at bedtime, warfarin with dose adjusted according to INR, allopurinol 150 mg PO daily, metoprolol 25 mg PO BID, and sodium bicarbonate 650 mg PO TID. Fasting laboratory results from one day prior to office visit showed glucose of 82 mg/ dL, BUN 20 mg/dL, serum creatinine 1 mg/dL, eGFR >60 ml/ min, Na 142 mmol/L, K 4.1 mmol/L, Cl 104 mmol/L, CO2 30.8 mmol/L, HbA1c 5.6%, hemoglobin 11.9 g/dL and hematocrit 35.2%. His urinalysis was normal. His resting BP was 150- 160 mmHg systolic and 100-110 mmHg diastolic, and pulse 64 beats/min.
The abdomen could not be examined for bruit because of his disability. At this visit, metoprolol was switched to atenolol 50 mg PO daily, insulin detemir was put on hold, and chlorthalidone 12.5 mg PO daily was prescribed to achieve BP control. He returned to the office four weeks later. On this second visit, his pulse rate was 80 beats/min and resting BP was 140/100 mmHg. A laboratory report, done two weeks after the first visit, without insulin or oral hypoglycemic therapy, showed FBG and 2 hPPG 131 mg/dL and 134 mg/dL, respectively. His kidney function was slightly reduced with eGFR of 56.7 ml/min in both periods. HbA1c was 5.4% and average glucose was 108 mg/dL. Atenolol was increased to 50 mg PO a.m., and 25 mg PO p.m. to achieve BP control. All other medications remained unchanged. At the third visit in mid-March 2012, his sitting BP was normal (110-100/70/80 mmHg) pulse rate was 58 beats/min. Most current laboratory showed FBG and 2 hPPG were 132 mg/dL and 118 mg/dL, respectively. Renal function decreased further, with eGFR of 51.9 ml/min and 47.9 ml/min in fasting and 2hPP periods, respectively. This decrease in renal function is most likely due to chlorthalidone. Thus dosage of chlorthalidone was reduced to Monday, Wednesday and Friday.
Patient #3 – 64 year old African-American male was referred for uncontrolled hypertension and hypokalemia. His medication consisted of diltiazem CD 360 mg PO daily, amlodipine 10 mg PO daily, Triam/HCTZ 37.5/25 mg PO daily, and KCl 20 mEq TID. Laboratory results are shown in Table 1.
Here is a patient who developed severe hyperglycemia mimicking diabetes in 2009, but glucose levels became normal upon discontinuation of triamterene/hychlorothiazide. He continued to take potassium chloride supplements. Thus it is safe to inform the patient that he does not have diabetes now but has a risk of developing diabetes in the future because of a high insulin response.
Patient #4 – 83 year old white male weighing 287 pounds and with pre-existing congestive heart failure (CHF), aortic stenosis, and aortic insufficiency with shortness of breath even with continuous oxygen therapy, and swelling of both lower extremities has been followed in the office of the corresponding author since the beginning of 2007. His treatment consisted mainly of Triam/HCTZ 37.5/25 PO daily, with intake of potassium chloride 10 to 20 mEq PO daily. Intermittently, additional diuretics such as furosemide 20 to 40 mg daily and metolazone 2.5 to 5 mg PO per day supplemented his therapy. Over time, his shortness of breath and swelling of the lower extremities decreased requiring decreased dosage of diuretics until the end of 2010 when Triam/HCTZ was put on hold and metolazone was reduced to 2.5 mg PO on Tuesdays and Thursdays only. A laboratory has accompanied every office visit and serum glucose levels varied from normal to high, depending on the number of diuretics used, until 2010 when the glucose level remained consistently elevated. In September of 2010 he was placed on glipizide 5mg PO with lunch and dinner, but glucose levels markedly increased despite discontinuing use of diuretic(s). In mid-January of 2011, his FBG and 2hPPG were 307 mg/dL and 468 mg/dL, respectively. He was started on Glargine insulin, 25 units subcutaneously after breakfast and again after dinner. Initiation of insulin treatment was followed by a steady decline of both FBG and 2hPPG to normal levels. His insulin dosage is reduced to 10 units after breakfast and dinner. In October of 2011 his HbA1c was 5.6% and average glucose was 114 mg/dL. His latest office visit in February 2012 revealed FBG and 2hPPG of 112 mg/dL and 101 mg/dL, respectively. Summary of his glucose levels in form of lows, highs, and mean levels from 2007 to 2011 are presented in Figure 3.
From Table 2 it should be noted that HbA1c is elevated until 2011, when it is reduced to normal level concomitantly with decrease of glucose levels to normal after initiation of Glargine insulin therapy. His renal function determined by serum creatinine is mildly impaired but it is non-progressive. He floridly responded to Glargine insulin with regression of hyperglycemia. He feels well and maintains normal blood glucose levels (FBG and 2hPPG) with 10 units of glargine insulin twice daily.
This study presents four patients who were treated with thiazide diuretic and developed hyperglycemia. Two patients were treated with oral hypoglycemic agents and one with insulin detemir. Discontinuation of thiazide diuretic resulted in restoration of normoglycemia and termination of oral hypoglycemic agents. Diabetes in insulin treated patient (Patient #2) could not be documented after discontinuation of insulin. Authors observations indicate that hyperglycemia of variable severity is common in hypertensive patients treated with diuretics, mainly thiazide diuretics. However, unlike other authors, these authors have demonstrated that hyperglycemia is reversible upon discontinuation of the diuretic as it is shown clearly in patient #3. However, a patients' glucose level may not decrease upon discontinuation of the diuretic as in patient #4.
This patient who has developed overt diabetes, requiring insulin therapy, raises an important question: does diureticinduced hyperglycemia lead to overt diabetes? To that effect other authors have asked the question "are antihypertensive agents simply unmasking or masking diabetes" [6]? Intracellular potassium deficiency even with near normal serum potassium, is an important determining factor for hyperglycemia induced by diuretic therapy, and correction of hypokalemia using potassium supplements attenuates hyperglycemia [7].
Low serum potassium has been considered an important mechanism in the pathogenesis of diuretic induced hyperglycemia by these and other authors [6,7]. It is important to understand that serum potassium does not necessarily correlate with intracellular potassium stores. Therefore serum potassium may be normal but intracellular potassium deficit still persists and hence may attenuate endogenous insulin release and cause hyperglycemia. Since it is difficult to measure intracellular potassium, we have to depend on serum potassium as an index of intracellular potassium. In patient # 4 for example, serum potassium levels varied between 4.2 and 4.4 mmol/L from 2007 to 2011 during continuous potassium supplementation and use of triamterene along with HCTZ. He still developed sustained hyperglycemia with time leading to overt diabetes and required insulin therapy to control glucose levels. A pearl of wisdom came from this patient where it was observed that control of persistent hyperglycemia with insulin therapy, markedly decreased his shortness of breath and he no longer requires oxygen therapy. He is more lively than before. To that effect, it is important to seek out mechanisms other than hypokalemia alone to explain hyperglycemia. As such, other authors have identified HbA1c (odd ratio 4.21 per 1% increment) as baseline predictor of diabetes [8]. The findings in our patient #4 concur with the previous observation. HbA1c in patient #4 increased from baseline 6.6% in 2007 to 9.8% in 2011 when he developed overt diabetes.
The problem of predicting cardiovascular or renal risk associated with drug-induced hyperglycemia still remains. There are several reasons for that: 1. Diuretic, especially thiazide diuretic, is an essential therapy in hypertension and 2. Hypertension in and of itself is associated with much greater cardiovascular and renal risks thus making it difficult to distinguish them from those caused by diuretic therapy. 3.
Most studies are post hoc findings and were not adequately powered to assess the association between diuretic therapy and new-onset diabetes [9]. 4. New-onset diabetes was defined differently in different studies [9]. Further, comparing antihypertensive drug classes is difficult owing to differing study designs [10].
It is evident from all previous studies and our own observations that use of diuretics in the treatment of hypertension or CHF gives rise to hyperglycemia. Thiazide diuretics such as HCTZ or chlorthalidone more often cause hyperglycemia than other diuretics. Severity of hyperglycemia varies but generally does not exceed 200 mg/dL (> 11 mmol/L) to call this condition established diabetes by definition. However, no prospective or long-term follow up studies are available to determine that diuretics merely cause hyperglycemia or unmask diabetes. Thus for now, diuretic-induced hyperglycemia is caused by volume and potassium depletion and treatment with potassium or reduction of the dose of diuretics reduce blood glucose levels to near normal or normal levels. However, there are exceptions to this dictum. As such occasional patients with use of multiple diuretics may give rise to symptomatic diabetes requiring insulin therapy. Except for that, no microvascular or macrovascular complications, unique for untreated diabetes, have been observed in diuretic-induced hyperglycemia.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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.
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!
"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 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 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 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.
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 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.
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.
“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”.
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.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
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.
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, 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.
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.
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, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
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!”
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
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.
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 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.
