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Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
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Dr. Mamta Gupta
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Aug 2018

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Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : OC32 - OC35 Full Version

Ambulatory Blood Pressure Monitoring in Normotensive Type 2 Diabetes Mellitus: An Observational Study

Published: January 1, 2023 | DOI:
Charan Neeradi, Bhavani Madduluri, R Venkateshwaran, Rathinam Palamalai Swaminathan

1. Assistant Professor, Department of General Medicine, ESIC Medical College, Hyderabad, Telangana, India. 2. Junior Resident, Department of General Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India. 3. Assistant Professor, Department of General Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India. 4. Professor, Department of General Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India.

Correspondence Address :
Charan Neeradi,
Puducherry, Hyderabad, Telangana, India.


Introduction: Hypertension (HTN) is a major cause of cardiovascular morbidity and mortality, particularly in diabetic people. Because HTN and Type 2 Diabetes Mellitus (T2DM) frequently co-exist, HTN is a significant risk factor for chronic problems masked HTN affects around a one third of T2DM patients who have normal Blood Pressure (BP) readings in the clinic. T2DM patients frequently have normal office BP (BP) and no nocturnal BP falling. The non dipping BP pattern raises the risk of cardiovascular events and damage to target organs. Multiple BP recordings can be obtained with Ambulatory BP Monitoring (ABPM). By providing variability of BP, and diurnal variation in BP, it assists the treating physician in the diagnosis and management of HTN.

Aim: To elucidate the prevalence of non dipping pattern in T2DM and the characteristics of diabetics who have non dipping pattern using ambulatory monitoring.

Materials and Methods: This was an observational study carried out in the Department of Medicine at JIPMER, Puducherry, India. Between January 2016 and December 2017, 110 patients with T2DM were visited to Medicine Outpatient Department (OPD) and the Diabetic Clinic. Out of 110, a total of 62 patients, with an average age of 46.67 years, were included in the study. Sun Tech Oscar 2’ 24 hourR ABPM system was used for the study of ambulatory BP of patients, at specified times.

Results: Sixty two normotensive T2DM patients, mean age of 46.67 years were analysed in the 24 months. A total of 62 patients, the non dipping pattern was seen in 47 (76%) of the 62 individuals evaluated for ABPM, while the dipping pattern was seen in 15 (24%) of the normotensive T2DM patients. A non dipping pattern was associated with a higher Body Mass Index (BMI) (p-value=0.03). A non dipping habit was also substantially associated with high Postprandial Blood Sugar (PPBS) values (p-value=0.02).

Conclusion: Patients with a history of HTN and smoking had a higher chance of non dipping patterns, which may lead to end-organ damage and future cardiovascular events. ABPM can be used as a screening tool to predict cardiovascular events in T2DM.


Cardiovascular events, Hypertension, Non dipping pattern

Co-morbidities such as HTN and T2DM are very common. In diabetic patients, HTN is twice as common as in non diabetic ones, and it is a prominent risk factor for the development of chronic problems in T2DM patients (1),(2),(3). On 24-hour ABPM, many diabetic individuals who are normotensive on regular clinic BP tests show aberrant BP profiles (4). In hypertensives, ABPM has been demonstrated to have a stronger connection with target organ damage than clinical BP monitoring. ABPM provides 24-hour BP profiles, encompassing daytime and night-time measurements, as well as the fluctuation in BP over a 24-hour period (5),(6). In the present study, standard deviation of average 24-hour, night-time, or daytime BP measurements was used to calculate 24 hour BP variability. This BP fluctuation is typically elevated in diabetics and it is an indirect predictor of disordered autonomic circulation control. The BP pattern is also provided by ABPM in the early morning hours. Morning HTN is more common in diabetic patients than in non diabetics and it predicts diabetic nephropathy development rate (7). The patient profile of non dippers and its prevalence in diabetics helps to consider early antihypertensive therapy and to assess the ABPM as a screening tool in T2DM in order to predict further development of HTN.

To date, no study has evaluated the prevalence of non dipping patterns in normotensive T2DM in India. The present study was undertaken to identify the prevalence of non dipping pattern in diabetic patients. If the non dipping pattern prevalence is high in diabetics, then screening with ABPM can be recommended to detect non dippers, so that lifestyle modification and therapy for preventing HTN-related complications can be initiated.

Material and Methods

This was an observational study carried out at JIPMER’s Department of Medicine on patients with T2DM who visited the Medicine OPD and the Diabetic Clinic between January 2016 and December 2017. The Institutional Ethics Committee (IEC) had approved the study (JIP/IEC/SC/2016/26/861). A total of 62 patients were included in present study. Consent from the participants was taken and confidentially of the data was maintained.

Inclusion criteria: Age >30 years, T2DM, normotensive patients (<140/90 mm Hg on two occasions atleast one week apart) were included in the study.

Exclusion criteria: Already on antihypertensive therapy or on drugs that are known to affect BP, known cases of systemic HTN, established coronary artery disease, heart failure, endocrinopathies other than diabetes, established nephropathy (macroalbuminuria >300 mg/24 hours, with albumin creatinine ratio of >34 mg/mmol), pregnancy were excluded from the study.

Study Procedure

Clinical and laboratory data were collected for all included patients using a standardised data collection form. The following data were collected- demographic data; clinical details like duration of diabetes, symptoms of hypothyroidism, snoring, history of smoking, treatment details for diabetes, family history of diabetes and HTN, BMI, waist to hip ratio, clinic BP at presentation, fundus examination for retinopathy; laboratory parameters like fasting and postprandial blood glucose, HbA1c, total cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Thyroid function test, urine albumin.

Measuring method: The Sun Tech Oscar 2ABPMR device was used. Oscilometry with step deflation to monitor BP. The measurements of BP were started between 8 am and 10 am and ended 24 hours later. Three sphygmomanometer readings and three single measurements with the ABPM recorder was taken to ensure that the difference between the two was no greater than 5 mmHg. The subjects were carefully instructed regarding the measurement protocol. Minimal physical activity was allowed, vigorous physical activity and caffeine intake was prohibited. They were advised to cease activity and keep the arm still at the onset of cuff inflation. For the 24-hour ABP recording, the recorder was programmed as follows: patient’s name, age, hospital number, height and weight, starting time and ending time were entered.

For each of the three measurement periods (24 hour, day and night), the systolic and diastolic means were calculated. The systolic and diastolic percentage dipping (normal >10%) were calculated. Individuals were classified as dippers based on the percentage of dipping if both systolic and diastolic dips were at least 10% (8).

Results of the ABPM recording were derived by using the following formula:

Dipping percentage=Day mean BP-Night mean BP/ Day mean BP

The ABPM recorder was linked to all of the patients for 24 hours. The mean 24-hour Systolic Blood Pressure (SBP), Diastolic Blood Pressure (SBP), mean daytime SBP, DBP and mean night-time SBP, DBP were recorded.

Statistical Analysis

Categorical variables were expressed as number and percentage and compared across the groups using Pearson’s Chi-square test for independence of attributes of categorical variables and student’s unpaired t-test to compare two groups and p-value <0.05 was considered as level of significance.


The patients’ mean age (SD) was 46.67±6.7 years, with 30 (48%) of them being men (Table/Fig 1).

At the time of presentation, the mean duration of diabetes was 3.5±3.1 years. At the time of enrollment, 50 (81%) patients were taking oral hypoglycaemic agents. A family history of diabetes was found in 33 (53%). A family history of HTN was found in 11 (18%) The mean SBP in the clinic was 113 mmHg, while the mean DBP was 75 mmHg. The mean BMI was 23.6 kg/m2 and the mean waist-to-hip ratio was 1.0 (Table/Fig 2).

(Table/Fig 3) summarises the findings of laboratory research. The fasting blood sugar level was 169±74 mg/dL, while the postprandial blood sugar level was 276±97 mg/dL. LDL cholesterol levels averaged 116±30.4 mg/dL. LDL levels were higher than 100 mg/dL in 43 (69%) of the individuals.

The clinical and analytical findings of the dipper and non dipper groups were compared (Table/Fig 4),(Table/Fig 5). A non dipping pattern was associated with a higher BMI (p-value=0.03). A non dipping habit was also substantially associated with high PPBS values (p-value=0.02).

SBP and DBP dipping percentages in the non dipper group were lower than in the dipper group which was 1 (2.13%) and 2 (4.25%) of non dipper in % Dipping SBP and DBP, respectively (Table/Fig 6).

Clinical features and dipping pattern are related: BMI and Postprandial Blood Sugar (PPBS) were shown to be substantially linked with non dipping pattern in univariate analysis (p-value 0.05). The correlation between these variables (BMI, PPBS) and dipping pattern was investigated using multivariate analysis employing multiple logistic regression methods, but no significant relationship was found. (Table/Fig 7) summarises the results of multivariate analysis.


One of the most important risk factors for the onset and progression of chronic complications in T2DM is HTN. ABPM has a better correlation with target organ lesions than office-based BP monitoring. It also allows for the assessment of various BP parameters such as 24-hour, daytime, and night-time systolic and diastolic BP means, BP loads, and the absence of nocturnal BP drops, as well as the detection of white-coat and masked HTN. The present observational study was conducted at a tertiary care centre in a south-Indian community. This study demonstrated ABPM to determine the prevalence of the non dipping pattern in normotensive T2DM patients. It also identified the non dipping pattern predictors.

Prevalence of non dipping pattern: The clinical outcomes seen in this study were similar to those seen in earlier trials. The non dipping pattern was seen in 47 (76%) of the 62 individuals evaluated for ABPM, while the dipping pattern was seen in 15 (24%) of the patients. Cuspidi C et al., reported a 58% incidence in normotensive middle-aged T2DM patients (9).

According to Pistrosch F et al., 70% of hypertensive type 2 diabetics do not dip (10). The non dipping trend was observed in 75% of hypertensive diabetics in the present study. The present study revealed a considerably higher prevalence of known dipping pattern than previous studies. The study done by Spallone et al. stated that decreasing vagal tone and increasing cardiac output can lower BP during the night in people with type 2 diabetic autonomic neuropathy (11). Hyperinsulinaemia was one of the other reasons for the non dipping trend. The average age of the non dippers was 46±6.4 years in the present study. The mean duration of DM at presentation did not differ significantly between the non dipping and dipping groups. A higher BMI was found to be connected with a non dipping habit. These findings were in line with earlier research. Kotsis V et al., found the incidence of non dipping BP to be as high as 71.4% in obese patients (12). Oxidative stress is the pathophysiological process behind postprandial hyperglycaemia and non dipping (13). By producing reactive oxygen species, postprandial hyperglycaemia plays a critical role in acute and chronic inflammatory processes, endothelial dysfunction and diabetic end organ damage. Multivariate analysis revealed that fasting blood glucose and HbA1c are not statistically significant predictors of non dipping pattern in this study. Smoking cigarettes decreases the circadian pattern of BP (11). Smoking is the greatest cause of atherosclerotic vascular disease, which results in non dipping BP. The present study found that just 4% of non dippers experienced symptoms of OSA. Ambulatory monitoring can rule out white coat high BP, preventing people from being prescribed BP-lowering drugs which they don’t need. It can also detect masked HTN, allowing people to receive the necessary BP medications. The present study also demonstrated that family history of HTN and smoking were associated with increased risk of developing a non dipping pattern. So these patients should be routinely screened for end-organ damage. As the prevalence of non dipping is high even in normotensive T2DM, ABPM can be recommended as a screening method for identifying the non dipping pattern in diabetic patients.


Firstly, though on univariate analysis higher BMI and higher PPBS were shown to have a significant association with the non dipping, they were not found to be significant predictors on multivariate analysis, which might be because of the inadequate sample size. Secondly, during the study recordings of ABPM were not repeated to see the reproducibility.


In normotensive T2DM patients, the prevalence of non dipping pattern was 76%, which could lead to end-organ damage and future cardiovascular events. As a result, ABPM can be utilised as a screening tool for T2DM patients to anticipate cardiovascular events. This study also discovered a link between on-dipping and a higher BMI, as well as postprandial hyperglycaemia. Current research also found that patients with a history of HTN and smoking have a higher chance of non dipping patterns.


Kalofoutis C, Piperi C, Kalofoutis A, Harris F, Phoenix D, Singh J. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Exp Clin Cardiol. 2007;12(1):17.
Leitao CB, Canali LH, Silverio SP, Gross JL. Ambulatory blood pressure monitoring and type 2 diabetes mellitus. Arq Bras Cardiol. 2007;315-21, 347-54.
Eguchi K, Kario K, Shimida K. Greater impact of co existance of hypertension and diabetes on silent cerebral infarcts. Stroke. 2003;34:2471-74. [crossref] [PubMed]
Staessen JA, Beilin L, Parati G, Weaber B, White W. Task force IV; Clinical use of ambulatory blood pressure monitoring. Blood Pressure Monitoring 19994:319-31. [crossref] [PubMed]
Angeli F, Reboldi G, Paltronlerl C, Verdecchia P. Interpretation of ambulatory blood pressure profile: A practical approach for clinicians. J Clin Exp Cardiology. 2013;4:07.
Felt-Rasmussen B, Borch-Johnsen K, Deckert T, Jensen G, Jenden JS. Microalbuminuria: An important diagnostic tool. J Diabetes and Its Complications. 1994;8(3):137-45. [crossref] [PubMed]
Fogari R, Zoppi A, Malamani GD, Lazzari P, Destrol M, Corradi L. Ambulatory blood pressure monitoring in normotensive and hypertensive type 2 diabetes. Prevalence of impaired diurnal blood pressure patterns. Am J Hypertens.1993;6(1):01-07. [crossref] [PubMed]
Lurbe A, Redon J, Pascual JM, Tacons J, Alvarez V, Batlle DC. Altered blood pressure during sleep in normotensive subjects with type I diabetes. Hypertension. 1993;21(2):227-30. [crossref] [PubMed]
Cuspidi C, Meani S, Lonati L, Fusi V, Valerio C, Sala C, et al. Short-term reproducibility of a non dipping pattern in type 2 diabetic hypertensive patients. J Hypertens. 2006;24(4):647-53. [crossref] [PubMed]
Pistrosch F, Reissmann E, Wildbrett J, Koehler C, Hanefeld M. Relationship between diurnal blood pressure variation and diurnal blood glucose levels in type 2 diabetic patients. Am J Hypertens. 2007;20(5):541-45. [crossref] [PubMed]
Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, et al. Cardiovascular autonomic neuropathy in diabetes: Clinical impact, assessment, diagnosis, and management. Diabetes/metabolism Research and Reviews. 2011;(7):639-53. [crossref] [PubMed]
Kotsis V, Stabouli S, Bouldin M, Low A, Toumanidis S, Zakopoulos N. Impact of obesity on 24-hour ambulatory blood pressure and hypertension. Hypertension. 2005;45(4):602-07. [crossref] [PubMed]
Ceriello A. New insights on oxidative stress and diabetic complications may lead to a “causal” antioxidant therapy. Diabetes Care. 2003;26(5):158996. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/56390.17397

Date of Submission: Mar 15, 2022
Date of Peer Review: Apr 16, 2022
Date of Acceptance: Nov 08, 2022
Date of Publishing: Jan 01, 2023

• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 21, 2022
• Manual Googling: May 14, 2022
• iThenticate Software: Nov 07, 2022 (11%)

ETYMOLOGY: Author Origin

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