A Game to Improve Blood Glucose Control

If you’re trying to improve your blood glucose control, playing an online game probably isn’t the first step you’d think to take. But according to a recent study, veterans with diabetes who played an online game with small financial incentives saw clear improvements.

The study, published in September 2017 in the journal Diabetes Care, involved 458 people — mostly men — receiving care through the Veterans Administration (VA) health system. Participants had to have a starting HbA1c level (a measure of long-term blood glucose control) of at least 7.5% and be taking at least one oral diabetes drug. Some also took insulin.

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How the game worked

Each participant in the study was randomly assigned to one of two groups.

In Group 1, participants played an online or phone-based game that asked four questions about diabetes management each week. Answers were revealed after each question, with an explanation. In Group 2 — known as the control group — participants played a similar game, but with questions related to civics and U.S. citizenship. Each group also received an informational booklet about the other group’s subject, so that by the end of the study, both groups had received the same information. The only difference was how it was received: by game or by booklet.

To raise the stakes of each game, participants were assigned to a team, and both team and individual scores (with aliases to protect privacy) were shown online on an ongoing basis. Each game lasted for six months, after which members of the winning team — as well as the top 30% of individuals — received a $100 gift certificate.

According to B. Price Kerfoot, MD, the study’s lead author, a similar game-based educational approach has already been shown to be effective among doctors, helping them improve both their clinical methods and patient outcomes. So for this study, he says, the goal “was to determine whether it could be even more effective when implemented directly with patients.”

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Veterans and diabetes: did you know?

• Nearly 1 in 4 veterans in the VA health care system has diabetes.
• Many Veterans of all ages are at risk for diabetes because of the high rate of obesity and those who are overweight, estimated at over 70% of Veterans receiving VA care.
• About 1 in 4 people with diabetes are unaware they have the condition.
(Source: Veterans Health Administration)

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Effects on blood glucose

In both Group 1 and Group 2, participants’ average HbA1c fell by a similar amount over the six months they played the game: from 9.0% to 8.6% in Group 1 (the diabetes game), and from 8.9% to 8.6% in Group 2 (the civics game).

But during the next six months, results between the two groups diverged. A year after the beginning of each game, Group 1 participants’ average HbA1c had dropped even further to 8.3%, while in Group 2, the number only dropped to 8.5%. Playing the diabetes game, it seems, had a longer-lasting beneficial effect on blood glucose control.

The results were even more pronounced among participants who started out with an HbA1c greater than 9.0%. In this segment of Group 1, HbA1c fell by an average of 1.49% a year later, a drop that Kerfoot says is “comparable to starting a new oral diabetes medication.”

Beyond the study

As Kerfoot notes, the study’s participants had characteristics that might have either enhanced or limited the effectiveness of the game-based approach to learning. “Veterans with diabetes tend to be male, older, and less comfortable with technology than other patient populations,” he notes. But because the study used an online enrollment form, it probably included veterans who were more comfortable with computers and mobile devices

The diabetes game used in the study is currently available to hospitals and health systems through a company called Qstream, so over time, it may become clear whether this approach is more or less effective in the general population than among veterans. But hospitals and health systems are unlikely to use monetary rewards in the same way that the study did, which could also affect results.

But despite these potential limitations, Kerfoot says, the idea of using online games to teach and reinforce diabetes management skills remains promising. All that you need to participate, he notes, are “a desire to improve your health, a competitive spirit, and a mobile device or computer.”

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Resources

• The VA’s MOVE! program can help veterans lose weight and improve blood glucose control
(Source: Veterans Health Administration)

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Want to learn more about strategies for managing blood sugar? Read “Making Your Blood Glucose Monitor Work for You” and “Managing Your Blood Glucose Ups and Downs.”