Online game boosts glycemic control in patients with type 2 diabetes
medwireNews: An online game delivering diabetes self-management education (DSME) helps improve glycemic control in patients with type 2 diabetes, study results suggest.
The randomized trial involved 456 eastern US veterans with glycated hemoglobin (HbA1c) levels of 58 mmol/mol and above who received DSME education, involving questions and answers on glucose management, exercise, long-term diabetes complications, medication adherence, and nutrition.
But they received the information in different formats; whereas 229 patients received it as a booklet, the remaining 227 received it while participating in an online game over a 6-month period. For control purposes, the patients receiving DSME as a booklet also participated in an online civics game on US history and government, while the patients participating in the DSME game intervention received the civics information in a booklet.
Participants taking part in the DSME game had a significantly greater improvement in HbA1c levels over 12 months than those in the civics game group, with reductions of 8 versus 5 mmol/mol, from baseline values of 75 and 74 mmol/mol, respectively.
The “sustained and meaningful HbA1c improvements” observed among those participating in the DSME game were of “a magnitude comparable to starting a new diabetes medication,” say B Price Kerfoot (Veterans Affairs Boston Healthcare System, Massachusetts, USA) and study co-authors.
“Of note, the control group also sustained substantial reductions in HbA1c,” they add, which is “not unexpected” based on prior research showing that DSME booklets can improve glycemic control.
Patient empowerment increased over the 6-month intervention period among those in the DSME game arm, as indicated by an average increase in Diabetes Empowerment Scale scores of 1.7 points, but decreased by 0.1 points among those in the civics game group. Participants in the DSME game group also experienced numerically greater reductions in diabetes distress scores during the intervention period, but changes in patient empowerment and distress scores were not significantly different between the two groups at the 6- and 12-month follow-up.
Together, these findings “show that an [online educational] game delivering DSME content to patients with diabetes over a broad geographic area generates short-term increases in patient empowerment and longer-term improvements in HbA1c, compared with a control intervention,” write the researchers in Diabetes Care.
And they say that because the study “was conducted remotely without requiring physical contact with patients and used in-home testing […] for outcome assessments,” the intervention is scalable to large populations and healthcare systems. Also, as the gaming intervention only requires patients to have an internet connection, it “could be deployed in geographically dispersed and remote health care settings.”
However, Kerfoot and colleagues caution that because enrolment in the trial required internet access, the study was enriched with participants who were comfortable using technology.
“This may limit its generalizability, as may the predominantly male veteran population from which we recruited,” they note.
Nevertheless, the team concludes that online games “may be an effective and scalable method by which to improve health outcomes in patients with diabetes and other chronic diseases.”
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