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Virtual reality's impact on children with type 1 diabetes: a proof-of-concept randomized cross-over trial on anxiety,
Noah Gruber1,2, Moran Shemesh-Iron3, Ethel Kraft3,4
1Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel. noahgruber@gmail.com.
Insights
Virtual reality (VR) significantly reduces pain and anxiety in children with type 1 diabetes (T1D). VR also improves adherence and glycemic control, offering a promising tool for pediatric diabetes management.
Area of Science:
- Pediatric Endocrinology
- Medical Technology
- Digital Health
Background:
- Type 1 diabetes (T1D) management in children presents challenges in adherence and glycemic control.
- Pain and anxiety are common during diabetes care procedures.
- Virtual reality (VR) is an emerging technology with potential therapeutic applications.
Purpose of the Study:
- To assess the effectiveness of virtual reality (VR) in managing type 1 diabetes (T1D) in children.
- To evaluate VR's impact on pain, anxiety, adherence, and glycemic control.
- To compare VR intervention with audio-guided imagery for diabetes management.
Main Methods:
- A randomized cross-over trial involving children with T1D using continuous glucose monitoring and insulin pumps.
- Participants were assigned to VR or audio-guided imagery interventions for one month, then crossed over.
- Outcome measures included pain, anxiety, adherence, glycemic control, and patient-reported satisfaction.
Main Results:
- VR intervention led to a 30% improvement in pain scores and a 14% reduction in anxiety from baseline.
- Significant improvements in glycemic control (time in range, time above range, glucose management indicator) were observed with VR.
- Patient-reported satisfaction and effectiveness were sixfold higher with VR compared to audio intervention, with improved adherence.
Conclusions:
- Virtual reality (VR) is effective in reducing pain and anxiety among children with type 1 diabetes (T1D).
- VR technology improves adherence, patient-reported outcomes, and glycemic control in pediatric T1D management.
- Incorporating VR into pediatric diabetes clinics can enhance patient coping and management strategies.
Aims:
Assess the effectiveness of virtual reality (VR) technology, in reducing pain and anxiety, and improving adherence and glycemic control among children with type 1 diabetes (T1D).
Methods:
Children with T1D, managed with continuous glucose monitoring and insulin pumps, were recruited for a randomized cross-over trial. Children were randomized to one of two interventions for diabetes management: group 1 used VR glasses first and group 2 listened to vocal-guided affective imagery first (audio). After 1 month, the interventions were crossed over. The outcome measures included pain and anxiety assessment, adherence, glycemic control, and patient-reported outcome measures (PROMs) of VR satisfaction and effectiveness.
Results:
Forty children, mean age 11.4 ± 1.8 years, were participated. During the VR part, the monthly mean pain score compared to the baseline improved in both groups by 30% (p = 0.03). A 14% reduction in the state anxiety score was observed from baseline to 1 month in both groups (p = 0.009). Glycemic control measures including time in range, time above range, and glucose management indicator improved in both groups during VR part (p < 0.004 for all), compared to audio part. After one month, the patient-reported outcome measure (PROM) of satisfaction and effectiveness was sixfold higher after 1 month in group 1 compared to group 2 (p = 0.002). Adherence improved for both groups.
Conclusions:
VR was shown to be effective in reducing pain and anxiety, improving adherence, PROM, and glycemic control among children with T1D. We suggest incorporating VR technology in pediatric diabetes clinics to facilitate and improve coping and management of diabetes.
Trial Registration:
Trial registration number and date of registration for prospectively registered trials:ClinicalTrials.gov Identifier: NCT05883267, May 10th, 2023.
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