A Team-Based Online Game Improves Blood Glucose Control in Veterans With Type 2 Diabetes: A Randomized Controlled...

Area of Science:

• Digital Health Interventions
• Chronic Disease Management
• Diabetes Self-Management Education (DSME)

Background:

• Limited evidence exists on the long-term effectiveness of online games for improving patient health outcomes.
• Diabetes self-management education is crucial for controlling hemoglobin A1c (HbA1c) levels.
• Digital platforms offer potential for scalable health interventions.

Purpose of the Study:

• To investigate if an online team-based game delivering DSME can lead to sustained improvements in HbA1c.
• To assess the impact of a DSME game compared to a control game on diabetes management markers over 12 months.

Main Methods:

• 456 patients with diabetes on oral medications and HbA1c ≥58 mmol/mol were randomized.
• Intervention group received a DSME game; control group received a civics game, both delivered via email or mobile app over 6 months.
• Primary outcome was HbA1c change measured over 12 months; participants earned points and were ranked on leaderboards.

Main Results:

• Patients in the DSME game group showed significantly greater HbA1c reductions (-8 mmol/mol) compared to the civics game group (-5 mmol/mol) over 12 months (P=0.048).
• Greater HbA1c reductions were observed in patients with baseline HbA1c >75 mmol/mol in the DSME group (-16 mmol/mol) versus the civics group (-9 mmol/mol) (P=0.031).
• The DSME game demonstrated sustained and meaningful HbA1c improvements, comparable to initiating new diabetes medication for poorly controlled cases.

Conclusions:

• Online games delivering DSME can effectively improve HbA1c levels in patients with diabetes.
• The DSME game offers a scalable solution for improving health outcomes in geographically dispersed populations with diabetes.
• Digital interventions like gamified DSME hold potential for managing other chronic diseases.