Background: Synchronous hybrid instruction offers flexible learning opportunities by allowing a portion of students to attend class sessions on campus while simultaneously allowing the remaining students to attend remotely. Although such flexibility may offer a number of advantages for pharmacy students, one area of concern is whether online participation options within synchronous hybrid courses can promote similar levels of engagement as courses that are designed entirely for face-to-face (FTF) participation. Objectives: The objective of this study was to evaluate the impact of synchronous hybrid instruction on pharmacy students’ engagement in a pharmacotherapy course. An evaluation was completed to determine if students were more likely to actively engage in class when they were participating remotely via teleconferencing technology or when FTF. Additionally, students’ perspectives were evaluated to determine their views of the benefits and challenges of the hybrid model for engagement in learning. Methods: The course utilizes team-based learning to apply critical thinking skills and develop a comprehensive care plan. A mixed methods approach was used to examine students’ engagement in the hybrid learning environment by quantitatively analyzing students’ responses to likert-scale survey items and qualitatively analyzing their responses to open-ended survey questions. Results: Students reported they were more likely to actively listen (p=0.004), avoid distractions (p=0.008), and react emotionally to a topic or instruction (p=0.045) when FTF. There were no significant differences found in student reported note taking, asking questions, responding to questions, or engaging in group work between the two modes of participation. Content analysis identified other benefits that supported student engagement, including perceived flexibility and enhanced ability to interact during class via the teleconferencing technology. For some students, challenges that negatively impacted engagement included difficulties with internet connectivity and a sense of dislocation or isolation in the course. Conclusion: This study demonstrated that when participating in a synchronous hybrid course, students participating remotely were less likely (compared to in-person attendance) to pay close attention and react emotionally, but were just as likely to take notes and communicate with teachers and groups. Key benefits of the hybrid approach were increased flexibility and the usefulness of online communication tools, while key challenges focused on technical and psychological isolation from others. The principles of flexible learning environments and self-regulated learning provide opportunities for pharmacy educators who are interested in improving hybrid instruction in the future.

Objective Assess evidence describing the effect of Sodium-Glucose Cotransporter-2 (SGLT2) inhibitors on total daily insulin (TDI) requirements in insulin-dependent patients with type 2 diabetes. Data sources A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols and Scoping Reviews (PRISMA-ScR) guidelines. The search was conducted in PubMed; citation mapping was completed in Web of Science. Filters for human studies, English language, and a publication date, from January 1, 2005 to April 12, 2021, were applied. Study selection and data extraction Studies assessing insulin dose requirements with concurrent use of an SGLT2 inhibitor for patients with type 2 diabetes were included. Data synthesis Sixteen studies were included and demonstrated that addition of an SGLT2 inhibitor typically reduced TDI requirements. Insulin reductions were often statistically significant, occurring in studies evaluating (1) within subjects who received SGLT2 inhibitors, and (2) between subjects receiving SGLT2 inhibitors versus placebo. Compared with placebo, insulin dose reduction ranged from −0.72 to −19.2 units. However, studies were relatively small, not designed to assess TDI change, and some utilized fixed dose insulin protocols or empiric insulin dose reductions. Conclusions Lowering insulin requirements may have benefits, such as decreased hypoglycemia risk, insulin resistance, and cost. Addition of an SGLT2 inhibitor may modestly reduce TDI requirements for patients with type 2 diabetes. Evidence indicating SGLT2 inhibitor use reduces TDI may lead to additional implementation in practice and inform future research. Further research is needed to clarify insulin type (i.e., basal or prandial) and degree of TDI reduction expected with addition of an SGLT2 inhibitor.