Videogames in Diabetes

Abstract

Gaming can be defined as a physical or psychic activity subjected to specific rules and dedicated to pleasure and fun. Emergence of novel technologies in the last three decades has resulted in the development of many videogames for personal computers, game consoles, tablets, and smartphones. Videogaming is an increasing entertainment activity worldwide. Videogame developers not only target children and adolescents but also adults who now represent a significant market share. Among videogames, the special category of serious games (SG) tends to grow significantly. A SG is a game designed for a primary purpose other than pure entertainment. This kind of software refers to products used by industries like defense, education, scientific exploration, emergency management, city planning, engineering, politics, and health care. In this latter setting, the neologism edutainment (education-entertainment) is also sometimes used to define this type of application that may indeed have a use for therapeutic education in chronic disease. The concept is to introduce some educational content in a videogame specially designed for this purpose: the entertainment content aims to boost adherence to the product and improve its educational impact. Type 1 diabetes has been one of the first health topics for which SG were developed. The rational was that this chronicle disease requires extensive education about self-care management and that this condition mainly affects children and young adults, a population prone to use videogames. First productions were created in the early 1980s, but main SG for diabetes were subsequently developed after the 2000s. Indeed, the release in 2002 of “America’s Army,” a SG developed by the US military department to improve its image among population, laid the foundation of modern SG. During the last 15 years, more than a dozen SG were developed for diabetes [1–3]. Most of them were developed on actually outdated platform and are no longer accessible. However, some of them are still available like “dBaza Diabetes Education for Kids” (http://dbaza.com/diabetes-education-for-kids.html), “Escape from Diab” (www.escapefromdiab.com), “Mr. Birman’s File,” or “Time Out” (these two latter games are available at no cost on http://gluciweb.com). Most of the SG for diabetes rely on the concept of situational problem solving: the player has to manage several diabetes situations in order to gain knowledge about diabetes management. In theory, the ultimate goal for the player is to transfer this knowledge into self-management of the disease. For example, in the SG “Mr. Birman’s File,” the main character (named Alex), is an investigative journalist and has type 1 diabetes. The player should help Alex to investigate the kidnapping of a famous scientist (entertainment content) while daily managing his type 1 diabetes (educational content). The adventure is indeed punctuated by diabetes management during meals, snacks, and physical activity. A diabetes simulator based on a validated metabolic model allows realistic interactivity between therapeutic decisions and glycemic consequences [4]. Based on the flexible insulin method, the player has to choose the adapted prandial insulin dose required for each meal presented as a detailed picture (Fig. 10.1). If the insulin dose performed is not adapted to the amount of carbohydrate, Alex may experiment hypo- or hyperglycemic episodes that the player has to correct with appropriate snacks or additional insulin injection. The entertainment adventure is hindered if diabetes management fails, motivating the player to perform well on the choice of insulin doses if it wants to complete the game. A scoring system allows to assess the player progression in the game and his ability to manage diabetes situations.