Competitive Diabetes Education Game Helped Veterans Control Blood Glucose

New research indicates that veterans who played a diabetes education game in teams demonstrated greater improvements in blood glucose control than veterans who learned about diabetes management from a booklet.

In the study, published in Diabetes Care, 456 veterans with diabetes were recruited to take part in the diabetes self-management education intervention. Half were assigned to a diabetes education game and were given a printed pamphlet about civics, while the other half were assigned to play a civics education game and received a pamphlet about diabetes management.

The diabetes education game included a number of mechanisms intended to boost engagement. After answering a multiple-choice question about glucose management, exercise, diet, or another topic related to managing their diabetes, players would immediately receive the correct answer, an explanation, and further references. Over the course of the 6-month intervention, they were given 2 questions each Tuesday and Thursday via e-mail or a mobile app.

Players were also grouped into regional teams and were awarded points for each question answered correctly. Leader boards featured individual and team scores in order to make the game more competitive, and winning teams and individuals received “modest financial rewards.”

After 12 months, the patients who had played the diabetes game demonstrated greater reductions in glycated hemoglobin (HbA1C) levels (—8 mmol/mol, or 0.74%) compared to those who had played the civics game (–5 mmol/mol, or 0.44%). This effect was even more pronounced among those who had poor glucose control prior to the intervention, as defined by HbA1C levels of at least 9%. These diabetes game players experienced a 16 mmol/mol drop in HbA1C over 1 year, while the control group saw theirs decrease by 9 mmol/mol.

“Among the subgroup of patients with uncontrolled diabetes, we saw a reduction in HbA1C levels that you would expect to see when a patient starts a new diabetes medication,” study author B. Price Kerfoot, MD, EdM, said in a press release from Brigham and Women’s Hospital. “Although their blood glucose levels were still above the target range, this was a strong step in the right direction, and resulted in a sustained and meaningful improvement in blood glucose control.”

The researchers acknowledged that they could not determine what specifically led to the improvements in blood glucose (ie, the game’s educational content, the sense of competition, or a combination of factors). Still, they noted that patients reported high satisfaction with the game, indicating its utility beyond diabetes management education.

“About 89% of participants requested to participate in future programs using this game,” explained senior author Paul R. Conlin, MD. “This approach could be an effective and scalable method to improve health outcomes for other chronic conditions as well.”