What can a guessing game played on a wireless hand-held device do for diabetes management? A lot, according to a pilot study led by researchers at Joslin Diabetes Center in Boston. The study was conducted in cooperation with a student at Harvard Medical School and a professor at the Massachusetts Institute of Technology.

The study, recently published in Diabetes Technology & Therapeutics, found that youth ages 8-18 with type 1 diabetes were more apt to monitor their blood glucose levels more often when engaged in a game called DiaBetNet” - an application that integrates blood glucose, insulin dosing, and carbohydrate intake data and challenges users to predict their next blood glucose levels.

DiaBetNet was created by Vikram Kumar, a medical student at the time in the Harvard-MIT Division of Health Sciences and Technology, together with MIT Professor Alex Pentland, Ph.D., and Lori Laffel, M.D., M.P.H., head of Joslin’s Pediatric and Adolescent section.

The study, Daily Automated Intensive Log for Youth (DAILY), headed by Dr. Laffel, looked at how a wireless-equipped personal digital assistant (PDA), linked with blood glucose management software and DiaBetNet, could assist in diabetes management among youth. “Research has shown that more frequent monitoring of blood glucose levels improves diabetes control, so we’ve been looking for approaches that encourage patients and their families to monitor their blood glucose levels,” Dr. Laffel said. Improving diabetes control helps to prevent complications, such as blindness, stroke, and kidney disease, which are associated with prolonged high blood glucose levels.

About the DAILY Study

The four-week pilot study trial included 40 children and adolescents with type 1 diabetes who were receiving their care at Joslin Clinic in Boston. The participants were divided into two groups: the Game Group and the Control Group. The Game Group received a blood glucose meter, PDA with data management software, and DiaBetNet software, while the Control group received the meter and PDA with data management software, but no DiaBetNet.

All participants were asked to check their blood glucose levels four times per day, upload their blood glucose readings, insulin doses, and carbohydrate intake into the PDA, and transmit the data daily. The Game Group participants, however, were instructed to access DiaBetNet before taking their fourth daily blood glucose reading. DiaBetNet integrated participants’ glucose, insulin and carbohydrate data, offered a graphical presentation, and prompted them to guess their fourth blood glucose reading of the day. These participants received a fixed number of points for playing the blood glucose guessing game. The data stored in the PDAs from both groups were wirelessly transmitted to a central secure server.

DAILY Results

The study found that 78 percent of the Game Group participants checked their blood glucose four or more times daily compared to only 68 percent of the Control Group participants. Game Group participants also had fewer episodes of hyperglycemia (elevated blood glucose), with 318 instances reported vs. 377 instances reported by Control Group participants. What’s more, surveys given to all participants before and after the study showed an increase in diabetes knowledge among all participants, with a significant increase in knowledge only among the Game Group participants. “We are encouraged by the results of this pilot study. It demonstrated the ease of introducing new technology to pediatric patients with diabetes, with an additional benefit of increased blood glucose monitoring among the Game Group participants,” Dr. Laffel said.

Katherine Wentzell of Joslin’s Pediatric and Adolescent Section , and Tarjei Mikkelsen of Dimagi, Inc., also contributed to this study. The DAILY study was funded by Roche Diagnostics Corp., the Hood Foundation, and the Katherine Adler Astrove Youth Education Fund. Vikram Kumar was supported by the Paul and Daisy Soros Fellowship for New Americans.