NIH K23 Grant Awarded to Christine March, MD, MS, Focuses on Collaborative Care for Pediatric Type 1 Diabetes in Schools

Christine March, MD, MS, assistant professor of Pediatrics in the Division of Pediatric Endocrinology at UPMC Children's Hospital of Pittsburgh, was awarded a four-year, NIH – NIDDK K23 mentored career development grant for her study titled "School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes." Dr. March’s research aims to develop and test a team-based intervention in the school setting to support the health and well-being of children with type 1 diabetes.

Bridging the Gap in Glycemic Control

Despite considerable progress in treatment methods and technologies that have emerged for T1D over the past few decades, the majority of young patients and their families struggle with achieving optimal glucose control in order to prevent acute and long-term complications that can arise from living with poorly controlled diabetes. Prior research by Dr. March suggests one solution might be to engage more collaborative, multidisciplinary care involving not just traditional health care providers but also community organizations and health care resources within schools and school districts.

“Diabetes can be very difficult for some families to manage,” says Dr. March “In addition to monitoring your glucose and taking your medication, you must think about how food, activity, and stress affect your blood glucose all day long. We need to leverage as many tools and resources as possible to give these children the best chance for long-term success.”

The School's Role in Diabetes Care: An Underutilized Resource

Schools play a crucial role in the management of childhood diabetes for a simple reason: children spend a great deal of time there. The UPMC Children’s Hospital diabetes team, in particular our diabetes care and education specialists, has a long tradition of collaborating with schools to provide the best care for patients. School nurses, who are trained medical professionals, are often on the front lines of diabetes care for these kids. However, their valuable input and expertise are not always utilized by the broader medical team that manages the child's diabetes.

Furthermore, while medical professionals specializing in diabetes care acknowledge the importance of schools in managing the condition, they seldom seek feedback or input from school nurses – data that has come to light in prior research and surveys conducted by Dr. March on the subject.

“The result is a siloed approach to care, where parents, school nurses, and diabetes providers are all involved but not effectively communicating or collaborating with each other,” says Dr. March. “While we know some of the barriers and factors that are at work in this dynamic, it can be highly variable because of differences at the state and local level across school districts.”

The main goal of Dr. March’s K23 research is to develop strategies to address these gaps and barriers, and pilot test an intervention that fosters better collaboration among parents, school nurses, and diabetes providers.

The SPACE Model

Dr. March's study will adapt the Collaborative Care Model, what she calls the SPACE model— originally designed and validated for use in primary care to improve behavioral health care — for T1D management.

The project is divided into three main aims. First, Dr. March’s study will work to identify the factors affecting implementation of diabetes interventions in school and specifically SPACE.

“I will be conducting surveys and interviews with school nurses in Pennsylvania and West Virginia to learn more about the barriers and potential strategies to introducing school-based diabetes care interventions,” says Dr. March. “We want to learn what are the pain points we could run into and how can we creatively overcome those to design an intervention that works and can be tailored to the local context.”

The second part of Dr. March’s research will be a community-partnered process that engages parents of children with diabetes, medical providers, school nurses and school administrators to iteratively adapt the collaborative care model through a process called human-centered design.

Subsequently, with eight school districts in western Pennsylvania, Dr. March will conduct a cluster-randomized controlled trial designed to test intervention's feasibility.

“The study will enroll children in elementary and middle school, and the school districts will be randomized to either receive or not receive the intervention during the first year,” explains Dr. March. “We’ll then flip that during the second year.”

While the primary goal of the study is to determine the feasibility of implementing such a care construct withing schools, Dr. March also will be evaluating secondary outcomes measures, like measures of glycemic control and quality of life, for future, more expansive trials.

“Ultimately what we want to know is if an intervention like what we will design has positive effects on glycemic control and psychosocial outcomes that are so important to long-term diabetes care and outcomes,” says Dr. March. “But the first step is feasibility, and that’s what this research will determine.”

Strong partnerships between medical centers, families, and school health staff might significantly improve the management of T1D among pediatric patients, thus reducing the risk of both short-term and long-term complications.

Dr. March's research offers a creative approach in the world of pediatric diabetes research and clinical intervention design. Her work will generate crucial preliminary data for future, more expansive trials aimed at rigorously testing a new school-based, community-based approach to managing T1D in young children and their families and will continue the long-standing history of collaboration at the Division of Pediatric Endocrinology, UPMC Children’s Hospital.

Further Reading

Read more about the grant on the NIH RePORTER website.

Learn more about Dr. March and the Division of Pediatric Endocrinology at UPMC Children’s.

Published Research by Dr. March

Read more about Dr. March’s past and ongoing research by visiting her PubMed listing.