Improving Health-Related Symptoms and Behaviors in Children and Adolescents Diagnosed With Diabetes by Using a...

Self-care plays an important role in improving health symptoms in patients diagnosed with chronic illnesses such as diabetes. Gamification is among the most effective methods for enhancing health monitoring by applying principles of behavioral economics and motivation.

This study aimed to develop an innovative self-care system using a virtual reality (VR)-gamified intervention and to evaluate its effects on patients diagnosed with diabetes metabolic symptoms and health-related behaviors compared to other standard interventions.

This study was a randomized controlled trial with a parallel-group design, conducted between December 2024 and February 2025. A total number of 78 patients diagnosed with diabetes were recruited from The Children's Medical Center clinic in a closed, offline setting. Briefing, tutorials, and interventions were partly face-to-face. Eligible participants (n=68) were randomly assigned to the 4 groups using stratified block randomization based on age and sex, with allocation concealment ensured through a sequentially numbered process. Each group received a different type of self-care intervention for 6 weeks, which was health care provider-assisted. One group received the VR gamified intervention, while the other 3 groups received comparator interventions, including the MySugr (mySugr GmbH) monitoring app, traditional counseling, and medication only, respectively. The primary outcomes were fasting blood sugar and health-related behaviors, including physical activity and food intake, while secondary outcomes were long-term metabolic indicators, including hemoglobin A_1c (HbA_1c) and BMI. All outcomes were measured by self-assessed questionnaires. No blinding was implemented for participants or care providers. However, data analysis was conducted using anonymized group labels. Eight participants were lost to follow-up. Minor missing daily entries were handled by weekly data aggregation.

Data from 60 participants were included in the final analysis (VR-gamified group n=16, application group n=14, counseling group n=15, and control group n=15). Linear mixed model showed significant time×group interaction effects for fasting blood sugar (F _15,280=2.046; P=.01; partial η²=.099), physical activity (F _15,280.61=2.544; P=.001; partial η²=.120), and food intake (F _15,336 =2.794; P<.001; partial η²=.111), indicating greater improvement over time in the VR gamification group compared with the other parallel groups. No statistically significant differences were observed for BMI or glycated hemoglobin. No serious adverse events related to the VR intervention were reported.

VR gamified self-care interventions may potentially contribute to better management of diabetes-related symptoms and behaviors compared with conventional self-care approaches. Such gamified VR systems show promise as alternative or complementary tools for enhancing health outcomes among children and adolescents diagnosed with diabetes.