BackgroundWe aimed to investigate the efficacy of ascorbic acid and acetylsalicylic acid among type II diabetes mellitus patients using metformin (only) for diabetes management therapy.MethodA 12-month single blinded multicenter randomized control trial was designed to investigate the measured variables [Glycated Hemoglobin (HbA1c), Renal function, Albumin Creatinine Ratio (ACR) etc.]. The trial was randomized into 2 experimental parallel arms (ascorbic acid vs acetylsalicylic acid) were blinded with study supplements in combination with metformin and findings were compared to control arm with metformin alone and blinded with placebo. Withdrawal criteria was defined to maintain the equity and balance in the participants in the whole trial.FindingPatients with metformin and ascorbic acid (parallel arm I) was twice more likely to reduce HbA1c than metformin alone (control arm) in a year (OR 2.31 (95% CI 1.87–4.42) p < 0.001). Also Parallel arm I was ten times more likely to reduced risk factors contributing to long-term diabetes complications than participants of arm II in a year (OR 10.38 (95% CI 6.91–15.77) p < 0.001). In contrast, parallel arm II patients were seven times more effective to reduce the risk of expected CVD development in 10 years than arm I (OR 7.54 (95% CI 3.76–10.32) p < 0.001).ConclusionsThe trial concluded that ascorbic acid with metformin is more effective against reducing risks for diabetes related long-term complications (including ACR). TRIAL details Registration No: NTR-6100, Registry Name: Netherlands Trial Registry, URL: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=6100, Date of Registration: 20th October, 2016, Date of first Enrollment: 1 November, 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-017-0584-9) contains supplementary material, which is available to authorized users.

Objectives The pharmacist faces need to provide clinical services to the patients and then the actual proficiency of the pharmacist can be judged. The aim of the study was to evaluate the elements of clinical knowledge, needs for clinical services, value of practice and confidence to practice among expatriate pharmacists (EPs) working in community pharmacies. Also determine the correlation pattern between the rudiments. Methods A survey‐based investigation conducted between December 2015 and May 2016 among EPs working in community pharmacies of Saudi Arabia. A total of 1007 community pharmacies (with 1897 EPs) were approached from four major cities of Saudi Arabia, that is, Riyadh, Jeddah, Madinah and Makkah. Cluster random sampling applied for distribution/selection of community pharmacies based on homogeneity and population density. Self‐developed bilingual questionnaire (face‐content validation performed with average reliability of 0.784 Cronbach's alpha) used to collect data, however only 1258 EPs responded with 66.31% response rate rest 639 EPs either denied to participate or incomplete responses. Ethics applied and approved from Taibah University research ethics committee. Key findings A total of 1258 EPs participated in the survey with mean ± SD age of 33.17 ± 4.759 years. Participants’ distribution pattern showed highest to lowest as Riyadh‐377 (30%), Jeddah‐315 (25%), Makkah‐302 (24%) and Madinah‐264 (21%) approximately. Findings showed different association patterns with; drug‐dose adjustment practices, defining critical symptoms with drug use for referral, developing pharmacoinformatic database and others. Total Mean ± SD for knowledge: 3.87 ± 1.172, Value: 4.12 ± 2.11, Need: 4.72 ± 1.788 and Confidence: 3.25 ± 1.021 (shows significantly High Need for practice: P < 0.001, ONE‐way ANOVA). Conclusions Conclusion of the study reflective to effective clinical services inbound with knowledge, need, value and confidence of a pharmacist. Expatriate pharmacists have a potential to work efficiently but they should equip themselves with appropriate competencies in order to transform clinical services at community level.

BackgroundThis study aimed to determine self-monitoring practices, awareness to dietary modifications and barriers to medication adherence among physically disabled type 2 diabetes mellitus patients.MethodsInterview sessions were conducted at diabetes clinic—Penang general hospital. The invited participants represented three major ethnic groups of Malaysia (Malay, Chinese and Indians). An open-ended approach was used to elicit answers from participants. Interview questions were related to participant’s perception towards self-monitoring blood glucose practices, Awareness towards diet management, behaviour to diabetes medication and cues of action.ResultsA total of twenty-one diabetes patients between the ages 35–67 years with physical disability (P1–P21) were interviewed. The cohort of participants was dominated by males (n = 12) and also distribution pattern showed majority of participants were Malay (n = 10), followed by Chinese (n = 7) and rest Indians (n = 4). When the participants were asked in their opinion what was the preferred method of recording blood glucose tests, several participants from low socioeconomic status and either divorced or widowed denied to adapt telemonitoring instead preferred to record manually. There were mixed responses about the barriers to control diet/calories. Even patients with high economic status, middle age 35–50 and diabetes history of 5–10 years were influenced towards alternative treatments.ConclusionsStudy concluded that patients with physical disability required extensive care and effective strategies to control glucose metabolism.Practice implicationThis study explores the patients’ perspectives regarding treatment management with physical disability.