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Meta-analysis determines that gaming may help patients with T2D attain glycemic targets and improve health outcomes.
Gamification as a self-care intervention shows promise in helping patients with type 2 diabetes lower their blood sugar and control their disease, according to a systematic review published in The Science of Diabetes Self-Management and Care.
“As clinicians, we realize that adults with type 2 diabetes (T2D) continue to face challenges with engaging in self-management behaviors,” Veronica Brady, PhD, RN, assistant professor in the Department of Research at Cizik School of Nursing with UTHealth Houston, says. “Those who are newly diagnosed, as well as people who have lived with the diagnosis for a long time, require education regarding self-care behaviors. We know that the traditional classroom method of providing education is often not the most effective. We wanted to find out if the use of gaming to provide diabetes self-management education would offer an effective alternative to traditional education methods and if the use of gaming improved diabetes outcomes.”
The researchers used the Embase, Web of Science, MEDLINE, and CINAHL databases to search for studies on the impact of gaming on self-management behaviors in patients with T2D. All studies in the review evaluated the effect of gaming on at least one of the self-management behaviors set forth by the Association of Diabetes Care and Education Specialists. These behaviors were healthy eating, healthy coping, exercise, self-monitoring, medication adherence, problem-solving (specifically, finding strategies to help manage their diabetes), and reducing risks by adopting healthy habits to help avoid complications of diabetes. Furthermore, studies included in the review were published between January 2013 and April 2022 and focused on adults who used video games, online games, virtual systems, or smartphone technology.
Dr. Brady and colleagues included nine studies in their review. Five studies were randomized controlled trials, whereas four were quasi-experimental studies. In total, the studies included 1,370 patients, with sample sizes as small as 10 patients and as large as 456 patients. Two studies were conducted in Germany, two in Switzerland, one in Australia, and four in the United States. Five studies included self-care behaviors, although none addressed the behaviors of problem-solving or medication use.
The researchers determined that eight studies were high quality, whereas one was medium quality. The behaviors most often addressed in these studies included physical exercise and healthy coping, and six studies used A1c levels as endpoints.
Improvements in Diabetes Self-Management
In two studies that used video games to promote healthy coping, patients did not report any change in QOL at the four-week and eight-week marks, whereas a third study described a significant improvement in QOL measurements (increase, 2.4 + 12.9%; P=0.03). These patients also reportedly experienced improved well-being (increase, 8.6 + 19.4%; P<0.001) and reduced diabetes-related impairment (5.2 + 13.2%; P<0.001) by the three-month mark. A virtual reality game also reportedly helped improve patients’ self-efficacy, whereas two online games yielded a nonsignificant improvement.
The two studies that evaluated changes in healthy eating found that a virtual environment and an online “game-like intervention” helped patients improve healthy eating habits, Dr. Brady and colleagues wrote.
Among eight studies that measured patients’ physical activity, two found that the intervention with video games helped patients increase physical activity, whereas one reportedly found no significant change. A virtual environment similarly did not appear to increase physical activity, whereas a smartphone game helped patients assigned to the intervention increase their movement by a mean of 3,998 steps (SD=1,293) per day, compared with just 939 steps (SD=1,156) in the control group. An online game reportedly prompted patients to exercise three days a week, up from one day a week.
Two studies focused on glucose monitoring. One was reported to have found that a virtual environment increased patients’ monitoring, though not to a statistically significant degree, whereas another increased the frequency of monitoring from one day a week to three days a week.
Games also helped patients reduce risk factors. Dr. Brady and colleagues cited one study of a virtual environment intervention that helped patients lose an average of 9.1 pounds and improved the frequency of foot care from an average of 3.68 days each week to 6.17 over six months.
Six studies examined glycemic outcomes. Of these, interventions in three studies reportedly helped patients significantly improve their glucose levels, whereas two studies showed nonsignificant changes, and one showed no changes.
“We found that gaming was an effective way to provide education and that games that involved competition were the most effective for keeping participants engaged and improved the attainment of goals, especially as it relates to physical activity,” Dr. Brady says. “I think the takeaway for clinicians is that games and apps can be an effective way to engage patients in self-care behaviors, and patients can engage in education activities in the comfort of their home (or anywhere else).”
Dr. Brady plans to conduct a study of her own to evaluate the effect of gaming in type 2 diabetes self-management.
“Our review included 9 studies conducted between 2013-2021, which suggest that gaming has not been well studied/implemented among the adult patient population with T2D. I would like to see more studies done in this area,” she concludes.
