Research Article | DOI: https://doi.org/10.31579/2640-1045/231
1 Department of Internal Medicine, Howard University, College of Medicine, 2041 Georgia Ave N.W., Washington, 20060, DC, United States.
2 Division of Endocrinology, Department of Medicine, Howard University, College of Medicine, 520 W St NW, Washington, 20059, DC, United States.
*Corresponding Author: Kanwal K. Gambhir, Professor and Director, Molecular Endocrinology Laboratory, Howard U. College of Medicine, HU Hospital Bldg 3C45, Washington, DC20060 202-865-1398, United States.
Citation: Victor D. Ellis, Maurice B. Fluitt, Kanwal K. Gambhir, (2026), Salient Features of Insulin Resistance in African Americans, J. Endocrinology and disorders, 10(3): DOI: 10.31579/2640-1045/231
Copyright: © 2026, Gambhir Kanwal K. This is an open-access article distributed under the terms of The Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 19 December 2025 | Accepted: 03 August 2026 | Published: 20 August 2026
Keywords: insulin resistance; African Americans; type 2 diabetes mellitus; adipose tissue distribution; mitochondrial dysfunction; chronic inflammation; epigenetics; social determinants of health; metabolic disparities; hyperinsulinemia
Insulin resistance (IR) is a central mechanism in the development of type 2 diabetes mellitus and metabolic syndrome, both of which disproportionately affect African Americans. This review synthesizes current evidence on the multifactorial causes of IR, emphasizing the intersection of molecular, epigenetic, and social structural determinants. At the cellular level, white adipose tissue dysfunction, characterized by impaired mitochondrial activity, oxidative stress, and chronic inflammation has emerged as a key driver of systemic insulin desensitization. Despite mitochondrial damage, adaptive mechanisms such as increased biogenesis and mitophagy can temporarily preserve metabolic balance. However, persistent metabolic stress and environmental exposures overwhelm these defences, leading to progressive insulin resistance. Among African Americans, the biological burden is magnified by social and structural factors, including chronic psychosocial stress, dietary inequities, and intergenerational epigenetic programming linked to systemic inequities. Together, these mechanisms illustrate that insulin resistance is not solely a metabolic defect, but a biocultural process shaped by both molecular pathways and lived social environments. Understanding these overlapping influences are crucial to developing targeted interventions that address the biological and social roots of metabolic disparities. Furthermore, that in African Americans the biological burden is increased by social and structural factors including chronic psychological stress dietary inequities, and intergenerational epigenetic programming linked systemic inequalities; Sirtuin 1 may be repressed in African Americans.
AKT – Protein kinase B
ATP – Adenosine triphosphate BAT – Brown adipose tissue BMI – Body mass index
CER – Ceramides
COX5B – Cytochrome c oxidase subunit 5B
DAG – Diacylglycerols
eIF2 – Eukaryotic initiation factor 2
eIF4-p70S6K – Eukaryotic initiation factor 4/p70 S6 kinase pathway
ESRD – End-stage renal disease
FH – Fumarate hydratase
FtMt – Mitochondrial ferritin
GLUT-4 – Glucose transporter type 4
HDL – High-density lipoprotein
HOMA-IR – Homeostatic model assessment of insulin resistance
HPA axis – Hypothalamic-pituitary-adrenal axis
HPG axis – Hypothalamic-pituitary-gonadal axis
IL-6 – Interleukin-6
IL-8 – Interleukin-8
IR – Insulin resistance
IRS – Insulin receptor substrate
mTOR – Mechanistic target of rapamycin
MeSH – Medical Subject Headings MnSOD – Manganese superoxide dismutase
OGTT – Oral glucose tolerance test
PA-1 – Plasminogen activator inhibitor-1
PKC – Protein kinase C
PON-2 – Paraoxonase-2
Prx-3 – Peroxiredoxin-3
ROS – Reactive oxygen species
SAAT – Subcutaneous abdominal adipose tissue
SAT – Subcutaneous adipose tissue
SSPG – Steady-state plasma glucose
TAZ – Transacylase Tafazzin
T2DM – Type 2 diabetes mellitus
TIMM8A – Translocase of inner mitochondrial membrane 8A TIMM17B – Translocase of inner mitochondrial membrane 17B
TNF-α – Tumour necrosis factor-alpha
UCP-1 – Uncoupling protein-1
VAT – Visceral adipose tissue
VAT/SAT ratio – Visceral-to-subcutaneous adipose tissue ratio
WAT – White adipose tissue
Insulin resistance (IR) does not exist in isolation. The aberration of molecular signalling that underlies IR initiates a cascade of compensatory disturbances across cellular pathways, ultimately leading to widespread systemic dysfunction. This phenomenon represents a pressing global health concern. According to the World Obesity Federation’s Obesity Atlas 2025, global obesity rates are projected to reach 17% in men and 22% in women by 2030, equating to nearly 3 billion adults, or roughly half of the world’s adult population, living with a body mass index (BMI) of 25 kg/m² or higher [1].
In the United States, obesity is defined as a BMI of 30 kg/m² or greater and affects an estimated 38.4% of adult men and 41.3% of adult women as of 2025 [1,2]. While the biochemical mechanisms of insulin resistance have been increasingly elucidated, the underlying causes of its development, and the reasons certain populations are more predisposed remain incompletely understood. This review aims to consolidate recent peer-reviewed evidence to define insulin resistance within a modern mechanistic framework, examine current hypotheses regarding its origins, and explore the biological and social structural factors that may explain why some populations, particularly African Americans, exhibit higher susceptibility to this metabolic aberration.
A comprehensive literature review was conducted to synthesize current evidence on the biological, molecular, and socio-structural determinants of insulin resistance (IR) in African American populations. Searches were performed in NIH National Library of Medicine, PubMed, Google Scholar, MDPI and Science Direct for peer-reviewed articles published from 2010 to 2025, ensuring inclusion of both foundational and recent studies. Key search terms included combinations of: “insulin resistance,” “type 2 diabetes,” “African American,” “Black,” “race,” “ethnic differences,” “adipose tissue,” “inflammation,” “mitochondrial dysfunction,” “HPA axis,” “cortisol,” “epigenetics,” and “social determinants of health.” Boolean operators and Medical Subject Headings (MeSH) were applied to optimize search specificity.
Studies were included if they reported data on insulin sensitivity or related metabolic pathways in African American adults, either alone or in comparison to other racial/ethnic groups, and if outcomes were assessed using validated measures (e.g., HOMA-IR, hyper insulinemic-euglycemic clamp, SSPG, or oral glucose tolerance tests). Exclusion criteria comprised studies lacking racial/ethnic subgroup analysis, animal-only studies without clear human relevance, as well as non-peer-reviewed publications.
Articles were screened by title and abstract for relevance, followed by full-text review. Data extracted included study design, participant characteristics, insulin sensitivity measures, and key findings regarding mechanistic contributors to IR. Findings were synthesized thematically across molecular, physiological, and social domains, emphasizing adipose tissue function, mitochondrial and oxidative stress pathways, hormonal regulation, genetic and epigenetic factors, and environmental or social determinants.
To address potential bias, study limitations were evaluated, including variability in insulin resistance measurement, sample size, and adjustment for confounders such as socioeconomic status, diet, and physical activity. The review emphasizes interpretation of racial and ethnic differences within a biocultural framework, considering both biological and social contributors to metabolic outcomes.
Known Mechanisms of Insulin Resistance
Adiposity and Lipo-toxicity
Current evidence strongly links insulin resistance to obesity; a disease state closely tied to excessive adiposity. However, this relationship is not uniform, as accumulating research demonstrates that adiposity is not the metabolic monolith it was once regarded as; the type and function of adipocytes play a more critical role than total fat mass alone. Adipocytes exist along a functional continuum, comprising three principal types: white, brown, and beige (or Brite) adipocytes [3].
White adipocytes, the predominant form in adults, primarily function to store energy in the form of triglycerides and cholesterol esters while secreting adipokines such as leptin and adiponectin. These cells are most strongly implicated in the development of insulin resistance and related metabolic disorders [3]. In contrast, brown adipocytes, localized in supraclavicular, mediastinal, and paravertebral regions, contain multiple small lipid droplets and are enriched with mitochondria expressing uncoupling protein-1 (UCP-1). This protein enables thermogenesis during cold exposure through sympathetic activation. Importantly, brown adipose tissue (BAT) activity declines with increasing BMI, fasting glycemia, and age, contributing to the loss of metabolic flexibility [3].
Beige or Brite adipocytes represent an intermediate phenotype located within white adipose depots. They share the thermogenic and mitochondrial features of brown adipocytes and can be induced by external stimuli such as cold exposure, physical activity, or hormonal signalling [3]. The ability of white adipose tissue (WAT) to undergo “browning” toward a more metabolically active state has thus become a focus of therapeutic interest in combating obesity-related insulin resistance.
In obese individuals, white adipocytes can comprise over 50% of total adipose tissue, compared to approximately 10% in lean individuals [4]. This expansion is not merely quantitative but also qualitative: adipose tissue functions as a major endocrine organ, influencing systemic metabolism through its secretion of adipokines, cytokines, and free fatty acids. Dysregulation of these secretory pathways contributes to chronic low-grade inflammation and impaired insulin signalling.
As white adipocytes hypertrophy beyond sustainable limits, several pathological processes ensue, including increased fibrosis, mitochondrial dysfunction, localized hypoxia, and disrupted adipokine secretion [5,6]. The resulting accumulation of toxic lipid intermediates and oxidative stress drives cellular injury and systemic inflammation phenomenon broadly described as lipo-toxicity. This lipotoxic state perturbs insulin signalling at both the receptor and post-receptor levels, manifesting as insulin hypersecretion and resistance. Central to these disturbances is mitochondrial dysfunction, which both amplifies and results from lipotoxic stress, linking adipocyte overload to impaired oxidative metabolism and insulin resistance, as discussed in the following section.
Mitochondrial Dysfunction
Mitochondrial dysfunction has emerged as a critical molecular contributor within the obesity–insulin resistance–metabolic syndrome spectrum [7, 8]. Although it may not represent the primary initiating factor in insulin resistance, mounting evidence suggests that mitochondrial impairment is central to the development and progression of metabolic pathology [9]. In aging-associated obesity, repression of mitochondrial electron transport chain complex IV subunit COX5B has been observed, correlating with reduced oxidative capacity and increased adiposity [10].
Obese individuals also exhibit decreased expression of the thioredoxin-dependent mitochondrial peroxidase Peroxiredoxin 3 (Prx-3), diminished activity of Paraoxonase 2 (PON-2), and overexpression of ferritin mitochondrial protein (FtMt)a key regulator of mitochondrial iron homeostasis [10]. Together with specific epigenetic modifications, these alterations enhance reactive oxygen species (ROS) production, promoting insulin resistance, β-cell hyperplasia, and adipocyte dysfunction [10, 11, 12, 13].
At the molecular level, mitochondrial impairment disrupts fatty acid β-oxidation, resulting in intracellular accumulation of lipid intermediates such as diacylglycerols (DAG) and ceramides (CER). These lipid species directly interfere with insulin signalling: DAG activates protein kinase C (PKC), which translocate to the plasma membrane and inhibits insulin receptor phosphorylation, while CER suppresses AKT activation, thereby impairing downstream insulin signalling [14, 15, 16].
Despite these deleterious effects, adipocytes retain intrinsic mechanisms that safeguard mitochondrial integrity and preserve metabolic stability. Interestingly, mitochondrial damage in white adipocytes does not invariably lead to metabolic dysfunction. For instance, mice with adipose-specific deletion of fumarate hydratase (FH) display distorted mitochondria and decreased ATP production yet remain resistant to obesity and insulin resistance, though this protection diminishes under thermoneutral conditions. Similarly, deletion of manganese superoxide dismutase (MnSOD) triggers a compensatory increase in mitochondrial biogenesis and respiratory capacity, protecting against diet-induced metabolic dysfunction [17, 18, 19].
Collectively, these findings underscore the dual nature of mitochondrial dysfunction in adipose tissue: while chronic dysfunction fosters ROS accumulation and impaired insulin signalling, adaptive mitochondrial stress responses such as mitophagy and mitochondrial stress signalling can preserve metabolic resilience and delay disease progression. These mitochondrial dynamics not only influence adipocyte function but also interact with the regional distribution of body fat, linking cellular energy metabolism to the anatomical determinants of insulin resistance discussed in the following section.
Location of Body Fat and Insulin Resistance
Although an elevated body mass index (BMI) is strongly correlated with the prevalence of obesity, emerging clinical and molecular evidence indicates that the distribution of adipose tissue serves as a more reliable predictor of metabolic dysfunction. The anatomical site of fat deposition, rather than total adiposity alone, is now recognized as a critical determinant of insulin resistance and the subsequent progression to metabolic syndrome. This concept, initially described as sex-dependent adiposity distribution, refers to the tendency for males to accumulate central or visceral fat, whereas females more commonly exhibit iliofemoral or peripheral fat deposition [20]. Clinically, individuals with central or abdominal obesity display a higher incidence of insulin resistance, dyslipidaemia, and cardiovascular morbidity compared to those with peripheral fat accumulation.
At the molecular level, visceral adipose tissue (VAT) and subcutaneous adipose (SAT) demonstrate distinct metabolic and endocrine characteristics. VAT is primarily composed of hypertrophic adipocytes that exhibit reduced insulin sensitivity, heightened lipolytic activity, and increased secretion of proinflammatory cytokines such as TNF-α and IL-
6. In contrast, SAT contains smaller, more insulin-sensitive adipocytes that maintain a greater capacity for lipid storage and secrete higher levels of adiponectin [11, 20].
Interestingly, even within SAT, regional variation exists; abdominal subcutaneous adipocytes exhibit metabolic profiles resembling those of VAT, underscoring the influence of local tissue environment on adipocyte function. Collectively, these findings demonstrate that the pathogenicity of adipose tissue extends beyond its total volume to encompass its regional distribution, cellular phenotype, and secretory behaviour.
This mechanistic interplay between adipose tissue distribution and its endocrine output forms the foundation for the chronic low-grade inflammatory milieu observed in obesity. The differential secretion of adipokines, cytokines, and chemokines from visceral versus subcutaneous depots provides an important link between adiposity patterning and the development of systemic insulin resistance, an interaction explored in greater detail in the following section.
Endocrine/Inflammation Influences
Historically, adipocytes were viewed primarily as passive energy reservoirs, storing fatty acids and glycerol as triglycerides. However, accumulating evidence now establishes that adipose tissue; whether white, beige, or brown functions as a dynamic endocrine organ. Adipocytes secrete a wide array of hormones and bioactive molecules, including steroid hormones (e.g., estrogen, cortisol), energy-regulatory hormones such as leptin, and multiple cytokines such as tumour necrosis factor-α (TNF-α), plasminogen activator inhibitor-1 (PAI-1), and angiotensinogen [21,22].
Leptin plays a central role in regulating satiety, reducing appetite, and increasing energy expenditure through its actions on the adrenal glands, thyroid, and the hypothalamic–pituitary–gonadal (HPG) axis [23]. Physiologically, leptin serves as a protective mechanism against obesity; individuals experiencing starvation consistently display reduced leptin levels compared with those who are well nourished. Experimental mice models reinforce this role: leptin deficiency or receptor knockout in mice results in marked adiposity, severe insulin resistance, and uncontrolled hyperphagia all of which are reversed by exogenous leptin administration [20,24,25]. Yet in human obesity, circulating leptin levels are typically elevated. This paradox reflects leptin resistance, in which the hypothalamus becomes insensitive to leptin’s regulatory signals. Hypothesized mechanisms include impaired leptin receptor signalling, increased C-reactive protein binding to leptin, and decreased histone deacetylase activity, all contributing to persistent overeating and weight gain despite hyperleptinemia [26].
Obesity, insulin resistance, and related metabolic disorders are also characterized by a chronic, low-grade systemic inflammatory state. This inflammation is partly driven by increased leukocyte infiltration into adipose tissue and elevated expression of pro-inflammatory cytokines particularly interleukin-6 (IL-6) and TNF-α [21]. TNF-α and its receptors play complex roles: while some in vivo work suggests protective functions against early insulin resistance [27], the predominant evidence indicates that elevated TNF-α contributes to metabolic dysfunction. Obesity-associated adipocyte hypertrophy is frequently accompanied by upregulation of TNF-α expression, although this is not observed uniformly across all populations [27,29,30]. TNF-α interferes with insulin action by reducing insulin-stimulated glucose disposal, promoting lipolysis, and inducing serine phosphorylation of insulin receptor substrate (IRS) proteins, thereby impairing downstream insulin signalling [22–30]. In addition, TNF-α stimulates the expression of other cytokines, including IL-6 and IL-8, further amplifying inflammatory processes implicated in insulin resistance.
IL-6, classically known to be pro-inflammatory, is produced substantially by adipocytes, and its circulating level is reliably elevated along the obesity–insulin resistance spectrum [22–30]. IL-6 directly reduces the expression of GLUT-4 mRNA and its associated transporter which are critical components for glucose uptake and thus directly contributing to insulin signalling defects. While IL-6 does not exert strong acute lipolytic effects on subcutaneous adipocytes, it rapidly diminishes insulin action by increasing the binding of the p85 subunit to IRS proteins, enhancing their ubiquitination and degradation. Notably, this mechanism is distinct from the serine phosphorylation pathway induced by TNF-α [22–30].
Together, these endocrine and inflammatory alterations illustrate how adipose tissue dysfunction drives systemic metabolic impairment. Importantly, the degree to which these mechanisms operate and the extent to which specific cytokines or hormonal pathways contribute to insulin resistance can vary among populations. These population-level differences are particularly relevant when examining insulin resistance in African Americans, a group disproportionately affected by obesity-related metabolic disease. Understanding how endocrine and inflammatory pathways manifest across diverse biological and social contexts sets the stage for the next section, which focuses on the measurable differences in insulin resistance in African Americans compared to other ethnic/racial groups.
Insulin Resistance in African Americans
Relevance
Although there has been a broader push to eliminate race-based approaches in medicine, race continues to influence clinical decision-making and health outcomes, often to the detriment of racial and ethnic minority groups. These long-standing assumptions about innate physiological differences based on appearance can negatively affect patient care. At the same time, racial disparities in health outcomes persist. Thus, while race is a social construct, it remains important to study how genetics, phenotype, social stressors, and environmental exposures intersect to shape disease risk among populations that experience disproportionate burdens of chronic illness [31,32].
Insulin resistance is central to the development of metabolic dysfunction, including glucose intolerance, dyslipidaemia, type 2 diabetes, hypertension, and cardiovascular disease. Each of these conditions and their resulting morbidity and mortality disproportionately affects African Americans compared with individuals of European ancestry. According to CDC data, non-Hispanic Black or African American adults experienced a 24% higher diabetes diagnosis rate than the overall U.S. population in 2024. In 2021, they developed end-stage renal disease from diabetes at 2.19 times the national rate, and by 2022 their diabetes-related mortality was 40% higher than the total population [33,34]. These persistent disparities underscore the importance of examining the biological, environmental, and structural contributors to insulin resistance specifically within African American communities.
Genetic and Epigenetic Factors
Although race does not reflect discrete biological categories, individuals of African ancestry may carry genetic or epigenetic patterns that contribute to differences in metabolic disease risk. Several studies have identified DNA methylation sites that differ significantly in African Americans. Chilunga et al. identified three uniquely methylated loci cg14013695, cg00456326, and cg20259981 with HOXA5 (cg14013695)
showing consistent hypomethylation across African and Mexican American populations and potential involvement in metabolic regulation [35]. The locus OSR1 (cg00456326), a tumour suppressor gene implicated in renal and gastric cancers, was found to be hypermethylated in African Americans. Although its precise role in insulin resistance is unclear, it correlates with altered phosphorylation responses to insulin [35,36].
More broadly, studies examining subcutaneous adipose tissue reveal 6,774 uniquely methylated genes in African Americans, many located in CpG regions implicated in obesity and insulin signalling [37,38]. Follow-up analyses show that insulin resistance in both adipose and skeletal muscle is tightly linked to altered expressions of genes involved in mTOR, eIF2, eIF4/p70S6K, and pathways regulating leukocyte chemotaxis such as NINJ1 [37,38]. Comparisons with European Americans, with and without diabetes, show only modest differences in methylation (2–3%), suggesting that even small epigenetic changes can influence metabolic phenotypes [28,39].
Body Fat Distribution and Skeletal Muscle Characteristics
As with European Americans, abdominal adiposity in African Americans correlates with reduced insulin sensitivity. However, the strength and nature of this association differ across ancestry groups. Early work by Karter et al. demonstrated similar glucose tolerance across ethnicities but found stronger associations between waist circumference and fasting insulin among European Americans, indicating that abdominal fat may exert ethnicity-specific metabolic effects [40].
More recent studies challenge assumptions of inherent ethnic differences in physiological insulin sensitivity. For example, direct comparisons between West African and European men revealed no differences in whole-body or tissue-specific insulin sensitivity. Instead, ethnic differences emerged in ectopic lipid deposition: intramyocellular and intrahepatic lipids were strongly associated with reduced insulin sensitivity only in White European men, not in West African men. Similarly, suppression of lipolysis correlated with intrahepatic and visceral fat exclusively in Europeans [41,42].
Studies in women show analogous complexity. In African American and Caucasian women, fasting glucose and triglycerides correlated with insulin resistance, but the triglyceride association remained significant only in African American women after adjustment. HDL cholesterol and
the TG/HDL ratio were robust predictors of insulin sensitivity in African American women but not in Caucasians. Additionally: BMI and percent body fat predicted insulin resistance only in Caucasian women, visceral adipose tissue predicted lower insulin sensitivity in both groups, thigh fat was metabolically protective only in Caucasian women, and adipocyte size showed minimal associations except among insulin-sensitive African American women [43].
Comparative work using diverse body composition measures has found that, for European Americans, higher BMI, total fat mass, subcutaneous abdominal adipose tissue, leg fat, and liver fat all predict lower insulin sensitivity (As shown in Figure 1). In African Americans, however, central fat is more strongly linked to insulin resistance, while peripheral fat correlates with preserved insulin sensitivity, patterns opposite to those observed in Europeans. Importantly, higher lean mass predicted lower insulin sensitivity in African Americans, suggesting that skeletal muscle may not convey the same protective metabolic effects seen in European ancestry populations [44].
Figure 1: Body Fat Distribution Patterns and Their Metabolic Effects Across Populations.
This figure compares how adipose tissue distribution influences insulin resistance in European Americans versus African Americans. Among European Americans, greater visceral adipose tissue (VAT) and higher levels of ectopic fat such as intramyocellular and hepatic lipid are strongly associated with reduced insulin sensitivity, while peripheral subcutaneous fat and greater lean mass tend to be metabolically protective. In contrast, African Americans show a distinct pattern: VAT demonstrates a stronger relationship to insulin resistance than overall adiposity, peripheral fat is less protective, and increased lean mass is paradoxically linked to lower insulin sensitivity. Additionally, ectopic fat stores show weaker metabolic associations, while heightened insulin secretion and reduced insulin clearance characterize their physiologic response. These comparative schematic highlights ancestry-specific metabolic phenotypes that influence insulin resistance risk.
Collectively, these findings indicate that insulin resistance in African Americans may not adhere to the traditional lipocentric model developed primarily from European-ancestry research. Instead, ancestry-specific patterns of muscle metabolism, adipocyte biology, and lipid handling appear to shape metabolic risk. Moreover, differences in measurement tools such as reliance on fasting insulin or HOMA-IR may artificially
magnify or obscure ethnic differences due to population-specific patterns of insulin secretion and clearance.
Mitochondrial Dysfunction
Mitochondrial dysfunction has recently emerged as a contributing factor to insulin resistance susceptibility. Early hypotheses suggested that individuals of African descent might possess unique mitochondrial genetic variations that predispose them to metabolic disease [45]. More recent research focuses on metabolic flexibility, the capacity of mitochondria to switch between available fuel sources depending on nutritional state. Impaired switching termed “metabolic inflexibility” is characteristic of the obesity–insulin resistance–type 2 diabetes continuum [46–50].
A key difference observed between African American and European American individuals is substrate preference: African Americans rely more heavily on glycolysis in both fasting and fed states, whereas Europeans typically oxidize fat during fasting and carbohydrates after feeding, reflecting distinct mitochondrial phenotypes [51–54].
Furthermore, lower expression of mitochondrial transport and import proteins; Tafazzin (TAZ), TIMM8A, and TIMM17B has been documented in African American women and may contribute to reduced mitochondrial efficiency [47–49,55]. These mitochondrial differences are thought to contribute to lower resting energy expenditure among African Americans relative to European Americans, although the complexity of genetic–environment interactions make it difficult to attribute such findings directly to insulin resistance risk [56].
Endocrine Influences
Endocrine function and inflammatory regulation also appear to differ across populations and may contribute to varying insulin resistance risk. One area of focus is cortisol regulation. In a study of 310 adults with type 2 diabetes, higher morning cortisol levels were associated with poorer glycaemic control and impaired pancreatic insulin secretion, independent of ethnicity [57]. When contextualized with research on racial discrimination and cortisol patterns, the implications become significant for African Americans.
A longitudinal study of adolescents aged 13–19 found that cumulative and peer-related racial discrimination were associated with a steeper diurnal cortisol slope; higher morning levels followed by a sharper decline throughout the day, which could be interpreted as dysregulation of the HPA axis [58]. This pattern corresponds to poorer glycaemic control and increased metabolic stress. Such findings highlight how social determinants can biologically embed through endocrine pathways.
Additional endocrine differences include higher insulin secretion and greater acute insulin responses among African Americans when challenged with insulin resistance. While initially compensatory, this hypersecretion may accelerate β-cell exhaustion, thereby increasing vulnerability to early insulin resistance and type 2 diabetes progression [59-61].
Taken together, these studies suggest that insulin resistance in African Americans arises from an interplay between environmental exposures (including chronic stress and discrimination), endocrine compensatory mechanisms, and distinctive metabolic responses. These interacting factors may accelerate the path toward insulin resistance and highlight the need for mechanistic models that account not only for biology but also for lived social experience.
Social Determinants of Health
A persistent structural challenge in the United States is the unequal distribution of wealth and opportunity across communities. This
inequitable system has been repeatedly shown to adversely affect population health. As discussed throughout this manuscript, socioeconomic conditions materially influence an individual’s susceptibility to developing insulin resistance and are increasingly recognized as drivers of epigenetic changes that may perpetuate risk across generations.
The primary and most consequential of these determinants is equal access. African Americans and other marginalized populations are disproportionately concentrated in geographic areas with limited access to essential resources such as comprehensive healthcare services and full-service supermarkets. These environments often promote unhealthy lifestyle patterns, whether due to enduring legacies of discriminatory policies or contemporary systems that purport to address disparities but inadvertently reinforce them [62,63]. The influence of place is so pronounced that a person’s ZIP code can often serve as a proxy indicator for their metabolic risk. For example, residence in areas with high supermarket density is associated with a lower risk of diabetes, whereas living in impoverished neighbourhoods confers a substantially elevated risk [64].
These disadvantaged regions commonly lack stable, high-quality food outlets offering fresh and nutritious options. In contrast, they tend to have a higher density of fast-food establishments and other sources of ultra-processed foods reenforcing dietary patterns that have been repeatedly shown to significantly increase the likelihood of developing insulin resistance and subsequent type 2 diabetes [65, 66]. Additionally, these communities often face limited access to safe and functional environments for physical activity, despite physical activity being a known protective factor capable of reducing insulin resistance by approximately 17 percent, independent of race, sex, or socioeconomic status [67].
Taken together, these social determinants underscore that insulin resistance does not arise solely from biological predisposition or individual behaviour but from structural conditions that shape daily living environments (As shown in Figure 2). Addressing the inequities in food access, healthcare availability, and opportunities for physical activity is therefore essential to reducing the disproportionate burden of insulin resistance and diabetes in marginalized communities. Interventions that prioritize resource redistribution, community-level infrastructure investment, and the dismantling of long-standing systemic barriers are likely to yield meaningful improvements in metabolic health and help disrupt the intergenerational transmission of risk.
Figure 2: Social Determinants Pathways from Environment to Insulin Resistance.
This figure illustrates the multilevel pathway through which structural and neighbourhood-level inequities shape metabolic health in African Americans. Structural factors including segregation, resource deprivation, and discriminatory policies produce environmental conditions characterized by poor food access, low walkability, limited healthcare availability, and chronic psychosocial stress. These exposures drive behavioural and physiologic responses such as higher intake of ultra-processed foods, reduced physical activity, cortisol dysregulation, sleep disruption, and compensatory hyperinsulinemia. Over time, these stressors contribute to epigenetic modifications, including altered DNA methylation patterns and changes in key metabolic signalling pathways, which enhance inflammatory activity and predispose to insulin resistance. The cumulative result is heightened metabolic risk with the potential for intergenerational transmission.
Insulin resistance (IR) in African Americans emerges from the convergence of biological, environmental, and socio-structural determinants rather than from any singular genetic or metabolic anomaly. The evidence synthesized in this review demonstrates that mitochondrial dysfunction, chronic low-grade inflammation, and altered adipose tissue distribution form the biological foundation of IR. Yet, these processes are amplified by social and environmental context nutritional inequities, psychosocial stress, and chronic exposure to systemic discrimination that impose cumulative metabolic strain. The biological expression of stress, through dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, aberrant cortisol rhythms, and compensatory β-cell hypersecretion,
exemplifies the biocultural embodiment of social adversity at the cellular level. Anti-Aging genes improve appetite regulation and reverse cell senescence and apoptosis in global populations (68,69,70). This suggest sirtuin1may be repressed in this population. Sirtuin 1 inhibitors may need to be consumed in African Americans.
While African Americans often display higher insulin secretion and reduced insulin clearance, these physiological features alone do not explain the disproportionate burden of IR and type 2 diabetes. Instead, the interplay between molecular vulnerabilities (e.g., epigenetic modifications in adipose and muscle tissue) and external stressors defines a unique metabolic milieu shaped by both ancestry and lived environment. Importantly, what have historically been interpreted as “racial” differences often reflect methodological variation in assessing insulin sensitivity and unmeasured confounding from structural senescence and apoptosis qualities rather than innate biological divergence.
Future research must move beyond reductionist racial comparisons toward integrative frameworks that couple precision molecular profiling with social epidemiology. This approach will clarify how gene–environment interactions and intergenerational epigenetic programming perpetuate metabolic disparities. Clinically, interventions that target both biological mechanisms, such as mitochondrial resilience and adipose tissue remodelling, and upstream social determinants, such as food access, chronic stress, and healthcare inequity, are most likely to reduce the disproportionate metabolic burden borne by African Americans.
Ultimately, insulin resistance is not merely a defect of metabolism but a reflection of embodied inequality. Recognizing its dual roots in molecular biology and social structure is essential to designing equitable prevention and treatment strategies that address the true causes of metabolic disease disparities.
Authors’ Contribution
Dr. Kanwal K. Gambhir conceived the idea and finalized the manuscript, Victor D. Ellis III drafted the first draft including all figures to fulfil the requirement of his senior year MSIV elective in endocrinology research Dr. Maurice B Fluitt edited the prefinal draft.
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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.
