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Background: Continuous glucose monitoring (CGM) is an evolving technology that provides a wealth of information to aid in managing diabetes. Professional CGM (ProCGM) is recommended when personal CGM is not desired or available. Patients in medically underserved areas may have limited access to personal CGM devices, thus ProCGM devices can be used for short-term monitoring and medication adjustment. Clinical pharmacists are well-positioned to help set up and establish personal and professional CGM management services. Objectives: To determine the effect of ProCGM in patients with persistently uncontrolled type 2 diabetes in a medically underserved population (MUP). Methods: Pre-post intervention analysis of a single cohort of patients in a public health center. Patients with persistently uncontrolled (A1c > 9%) and taking at least one daily dose of insulin were included. Included participants wore a ProCGM sensor and met with the clinical pharmacist at least once for ProCGM data interpretation and education. The primary analysis evaluated patients who achieved an A1c <9% 1-6 months after intervention. The change in A1c was also evaluated. Participants completed a pre- and post-survey about their experience. Results: Twenty-two patients were included in the final analysis. Ten patients achieved an A1c <9% (45%). The mean A1c pre- and post-ProCGM was 11.0% and 9.8% respectively, with a decrease of -1.2% (p=0.055) overall and a decrease of -1.7% for patients who wore the sensor for at least 10 days (p=0.012; n=15). Using the CGM data 91% of participants had a change to their medication regimen and 45% achieved an A1c <9%. Six participants experienced hypoglycemia per the CGM report, but only two were aware of it. After reviewing their glucose report with the pharmacist, 95% of the respondents agreed or strongly agreed to feeling more knowledgeable about blood sugar patterns after reviewing the report with a pharmacist. Conclusion: Almost half of the patients in the study achieved an A1c <9%. This study demonstrated glycemic benefit in patients in a MUP who wore a ProCGM for at least 10 days and met with a clinical pharmacist. Data from ProCGM enabled patients to better understand glucose patterns in those with persistently uncontrolled type 2 diabetes.

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OBJECTIVE: To determine if student peer- and self-grades correlate with faculty grades on case vignettes. METHODS: This study involved first professional-year students enrolled in an Integrated Pharmacotherapy course. The course included three modified team-based learning (TBL) activities (each consisting of individual and team readiness assurance tests, followed by three open-note case vignettes completed in teams). Each student uploaded completed case vignettes to the learning management system and was assigned to complete a self- and a random, anonymous peer-grade using a provided key. Peer- and self-grades were compared to faculty grades using a null multilevel model to determine the intraclass correlation coefficient (ICC). Faculty time spent grading was captured, and students were surveyed to determine the perceived value of peer- and self-grading. RESULTS: Faculty- and peer-grades had a slightly higher correlation than faculty- and self-grades (ICC = 0.75 vs 0.73, respectively). The ICC between all three grader groups was 0.74. Faculty spent an average of 2.5 h grading the cases after each TBL session. Students reported spending a median of 36 min on the peer- and self-grades for each TBL session. Overall, students agreed that both the self- and peer-grading activities helped identify gaps in knowledge (90% and 56%, respectively). A total of 78% of students agreed that self-grading was beneficial for their learning. CONCLUSION: There was a moderate-to-good correlation between peer-, self-, and faculty- grades for case vignettes. Faculty time may be saved through student self- or peer-grading.

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BACKGROUND: Clinical inertia is defined as the lack of treatment intensification in patients who are not at evidence-based goals of therapy; it may be related to provider, patient, and health system-wide factors. Patient factors, including nonadherence and tablet burden, are further compounded by health and social disparities present in safety-net clinics. Clinical pharmacist-based interventions may impact provider or health system factors to reduce inertia in patients with poorly controlled diabetes. OBJECTIVES: To evaluate the rate of clinical inertia between health care providers in a safety-net clinic. METHODS: A single-center, cross-sectional, retrospective study compared 2 cohorts of adult patients with type 2 diabetes and glycosylated hemoglobin (A1C) greater than 8% in 2016. Diabetes care was provided by clinical pharmacists in the intervention group and by primary care providers in the control group. The primary outcome was the difference in clinical inertia, measured by pharmacologic treatment intensification between groups within 4 months following the first A1C greater than 8% of the study period. RESULTS: Of 276 eligible patients, 72 were in the intervention group and 204 in the control group. There was no statistical difference between baseline A1C between groups, with an average A1C of 10.01% for the study population. In the pharmacist group versus provider group, the rate of overall treatment, noninsulin, and insulin intensification was 79% versus 49% (P < 0.001), 40% versus 32% (P = 0.19), and 54% versus 19% (P < 0.001), respectively. Patients were contacted an average of 4 times during the follow-up period in the pharmacist group as compared to 1 time in the provider group (P < 0.001). CONCLUSION: In this safety-net clinic, pharmacist-based interventions reduced clinical inertia in patients with poorly controlled diabetes. Future studies evaluating inertia long term and the impact on glycemic goals are needed.

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