AUCTORES
Globalize your Research
Research Article
*Corresponding Author: Yahya Bayazidi, Individualized Glycemic Control in Type 2 Diabetic Patients in Iran: A Multi-Center Data Analysis.
Citation: Abolfazl Sadeghi, Yahya Bayazidi, Majid Davari, Abbas Kebriaeezadeh, et al, (2023), Individualized Glycemic Control in Type 2 Diabetic Patients in Iran: A Multi-Center Data Analysis., J. General Medicine and Clinical Practice. 6(3); DOI:10.31579/2639-4162/107
Copyright: © 2023, Yahya Bayazidi. 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: 04 May 2023 | Accepted: 19 May 2023 | Published: 24 May 2023
Keywords: anxiety stress fear; Covid-19; hospitalization recurrence;
Background: Clinical guidelines and expert committees have recently suggested that the hemoglobin A1C (HbA1c) should be individualized based on various criteria. Data regarding the achievement of individualized glycemic targets in type 2 diabetes mellitus (T2DM) patients is scant in Iran. We intended to provide information found on real-world outcomes from the perspective of an individualized recommendation.
Methods: A cross-sectional analysis was conducted in 15 diabetes centers in Iran between 2013-2017. Two steps cluster sampling selection was used to recruit 1591 patients with T2DM. Considering Ismail-Beigi’s individualized strategy, the study population was categorized into five treatment intensities of HbA1c: most intensive (≤6.5%), intensive (6.5–7.0%), less intensive (~7.0%), not intensive (7.0–8.0%), and moderated (~8.0%). The percentage of patients who met their group individualized glycemic targets was estimated as the degree of achievement of each treatment intensity.
Results: The cumulative incidence rate of early microvascular, advanced microvascular, and macrovascular complications was 53%, 25%, and 34%, respectively. Besides, 78% [77.6-79%] of patients did not achieve individualized glycemic targets.
Conclusion: The outcome showed poor individualized glycemic control and a high incidence of diabetes complications. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need.
The foremost step in managing type 2 diabetes mellitus (T2DM) is targeting glycemic goals. [1,2], In Iran, the golden target of hemoglobin A1C (HbA1c) for managing T2DM is <7 href="https://ijms.sums.ac.ir/article_49006.html#ref7">7 have proposed the optimization treatment strategies to prevent diabetes complications. Moreover, in the last decade, clinical guidelines and expert committees have recommended that HbA1C should be individualized based on various criteria, including duration of diabetes, diabetic complications, socio-economic characteristics, comorbid conditions, life expectancy, and history of hypoglycemia. [8-10] According to Ismail-Beigi and others, the glycemic target (HbA1c) range for T2DM patients should be individualized based on age, diabetes duration, macrovascular and microvascular complications, and propensity for hypoglycemia. 11 Furthermore, careful consideration must be given to each patient’s capacities, desires, values, living situations, support systems, cognitive status, overall prognosis, and life expectancy. Consequently, glycemic targets should not be viewed as tight goals; they should be flexible and adaptable to changes based on patients’ health and living conditions. [12] The result of a patient-level Monte Carlo–based Markov model also showed that individualized control was a cost-saving scenario and would generate more Quality Adjusted Life Years (QALYs) than uniform intensive control (HbA1c level <7>
Iranian diabetic patients are expected to reach 5.2 million in 2025. [14] A previous study reported that Iranian patients with T2DM exert a significant burden on the healthcare system. 15 Additionally, the Iranian diabetes population has a high prevalence of long-standing diabetes and microvascular complications. [7] Analyzing the real-world outcome of the traditional guideline is vital before calling for any amendment in the treatment of T2DM.To the best of our knowledge, this study is the first evaluation in Iran to compare the real-world health outcome (HbA1c results) from the perspective of a personalized strategy.
Study Design
Clinical data extraction was performed from paper and electronic records at 15 diabetes centers (public, semi-public [centers related to the social security insurance organization], and private centers) in five provinces in Iran including Tehran, Isfahan, Yazd, Mazandaran, and Kurdistan.
Two-stage cluster sampling was applied to recruit the required sample size: 1) province selection (clusters) and 2) diabetes-center selection in the clusters. Subjects were selected by a random sampling method based on the patient identification number. The entire population was included since the center’s statistical population was small.
Subjects were eligible for inclusion in our study if they received diabetic routine care, regular glycemic control visits, laboratory investigations, and antidiabetic medications for at least five years. Written informed consent was taken from those aged 18 or older if they were willing/able to participate in the study.
Ethics approval was obtained from the Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.PSRC.REC.1396.1991).
Individualized Strategy
We defined individualized HbA1C targets according to the Ismail-Beigi methodology by considering multi-variables, including HbA1C, duration of diabetes, age, and history of microvascular and macrovascular complications.
Duration of diabetes is defined as the difference between the patient’s age and the age of diabetes diagnosis. The short duration was determined as five to ten years; while over ten years was taken as a long duration, and advanced age was considered for subjects aged 75 or older. Macrovascular complications are regarded as the diagnosis of the following: heart failure, angina, myocardial Infarction, and stroke. Advanced microvascular complications are defined as having one or more of the following: receipt of nephrology care (dialysis in the past 12 months), macroalbuminuria (the ratio of albumin to creatinine >300 with CACR test), blindness, severe neuropathy, and amputation.
Treatment intensities (HbA1C targets) were defined based on the chosen individualized recommendations as: most intensive (≤6.5%), intensive (6.5–7.0%), less intensive (~7.0%), not intensive (7.0–8.0%), and moderated (~8.0%). The patients were assigned to each treatment intensity, then the percentage of T2DM patients who met their treatment intensity’ targets was extracted. Finally, the result of the individualized target was compared with the uniform conventional target (HbA1c<7>
Statistical analysis was performed using the STATA software version 14 for Windows (Stata Corp., College Station, TX, US). Based on the results of normality tests, continuous variables (i.e., duration of disease, glycemic indices) are presented either as mean±SD, and categorical outcomes (i.e., meeting the preset glycemic targets) are demonstrated as proportions (95% confidence interval [95% CI]) or mean±SEM.
Patient Characteristics
In total, 1591 patients with T2DMs were included in this study. Patient characteristics are shown in table 1. The mean age was 60, and 58% of patients were women. The mean HbA1C in all patients for five years (2013-17) was 7.56, and 33% had a short disease duration. The cumulative incidence rates of macrovascular, microvascular, and advanced microvascular complications were 34%, 53%, and 25% over five years, respectively. The results showed an increase of 11.5% in the incidence rate of macrovascular complications and 19.43% in early microvascular complications over the period.
Table 1: Clinical and demographic information of type 2 diabetes patients
Using Ismail-Beigi and colleagues strategy and including clinical information, the study population were stratified and simplified in the five treatment intensities (HbA1c target). [11] Table 2 shows the percentage of the study population from 2013 to 2017 including in each of the five treatment intensities. We calculated the number of patients in each group who had met the group target and the average of the studied population who were in individualized targets. The details of the data are presented in table 3.
| Treatment intensity (HbA1c target) | Number of patients in each category N (%) | ||||
|---|---|---|---|---|---|
| 2013 | 2014 | 2015 | 2016 | 2017 | |
| Most intensive (≤6.5%) | 151 (9.54) | 137 (8.65) | 110 (6.95) | 93 (5.87) | 85 (5.37) |
| Intensive (6.5%–7.0%) | 410 (25.90) | 357 (22.55) | 326 (20.59) | 295 (18.64) | 241 (15.22) |
| Less intensive (7.0%) | 309 (19.52) | 338 (21.35) | 368 (23.25) | 393 (24.83) | 425 (26.85) |
| Not intensive (7.0%–8.0%) | 551 (34.81) | 578 (36.51) | 579 (36.58) | 576 (36.39) | 573 (36.20) |
| Moderated (8.0%) | 162 (10.23) | 173 (10.93) | 200 (12.63) | 226 (14.28) | 259 (16.36) |
Meeting Individualized Targets
Table 2: Patients in each treatment intensity category
Twenty-one percent of patients (21.8 and 22.7% from 2013 to 2017) met the individualized glycemic targets. At the same time, about 32% (32 and 31% from 2013 to 2017) of the study population were within the target for uniform conventional recommendation (<7>(table 3).
Achievement of individualized HbA1c target levels showed that only one-fifth of patients with T2DM who regularly received diabetic treatment, were adequately controlled (21.88% [22.4-21%]). However, a study in the US 16 showed that 29% and 30 % of T2DM patients were out of the target control based on ADA guidelines and the Ismail-Beigi strategy, 11 respectively.
Another study conducted by Coons and colleagues reported that the level of glycemic control would be different from targets recommended by traditional guidelines if considering the age and comorbidities of each patient. It accentuated that more studies should be done to develop a methodology to individualize the HbA1C in Canada. 17 These crucial factors regarding traditional guidelines and individualized recommendations bring burning questions about the goal of diabetes translational and quality improvement studies. Studies show that the prevalence of major microvascular complications of T2DM patients in Iran is high. 18 Besides, cardiovascular complications related to diabetes are more frequent in Iran than in other Eastern Mediterranean and Middle Eastern countries. 19 In the same vein, our result showed an increase of 11.5% in the incidence rate of macrovascular complications and 19.43% in early microvascular complications over the study period (table 1).
On the other hand, the Iranian diabetes guideline, similar to the ADA guideline, recommends that the HbA1C should be less than 7% for managing T2DM. 5 However, several studies reported that most patients with T2DM did not reach this target. 20 , 21 It is reasonably expected that this inadequate glycemic control will increase diabetes complications, decrease the patient’s quality of life, and intensify the disease burden for the patients and the healthcare system. Therefore, we suggest that diabetes guidelines be re-evaluated from various health-related facets, and individualized strategy is one of them.
The data regarding the achievement of individualized HbA1c targets in T2DM patients is scarce in Iran. We intended to provide information illustrating the pharmaceutical health outcome from the perspective of an individualized strategy proposed by Ismail-Beigi and others. 11
The central goal of recommendations to individualize glycemic targets (HbA1c) is to increase the health outcomes in the diabetes population. In fact, individualized recommendations encourage more intensive glycemic control for younger T2DM patients with fewer comorbidities to prevent macrovascular and microvascular complications in the long-term and more relaxed glycemic control for elderly patients and those with the risk of hypoglycemia or those with multiple comorbidities. 4 , 22 , 23 Moreover, as part of selecting wisely, the American Geriatric Society has warned about intensive glycemic control in older patients with diabetes by prescribing medications other than metformin. 24 Overtreatment in elders means using glucose-lowering medicines (except metformin) to achieve a tight HbA1c target that might surge the risk of hypoglycemia. 25 , 26 Studies showed that older patients with T2DM might have more restricted HbA1C <7 href="https://ijms.sums.ac.ir/article_49006.html#ref27">27 which illustrates overtreatment in some elders according to individualized recommendations. 25
Comparing our results with international evidence depicts the need for emergency amendments to Iranian diabetes management and a strong recommendation for considering individualized HbA1c targets. Nevertheless, it is clear that all required conditions for implementing the individualized strategy for managing diabetes, including education, financial resources, and healthcare facilities, must be considered in advance.
Our study had several strengths and limitations. We could declare that this study reflected the outcomes of real-world ongoing clinical practices as the data were collected randomly at the patient level from diabetic clinics. Despite these merits, our study had some limitations. The range of hypoglycemic episodes in over-treated patients was not assessed, as they were not documented in patients’ clinical information.
The outcome showed poor individualized glycemic control and a high incidence of diabetes complications in the population with T2DM in Iran. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need.
We thank all the staff of the Diabetes Research Centers that helped our research team to conduct this research.
AS, YB, MD, AA, AE, SY: the conception and design of the work, interpretation of the data, drafting of the article. All authors approved the present version of the manuscript. All authors agreed on being accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
None declared.
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
