Diabetes Mellitus II Education: A Low Carbohydrate Gaming Intervention for Improving T2DM Diet

Abstract

Background: Diabetes is one of the leading causes of death among adults worldwide, and the number of individuals affected continues to grow. The key to managing diabetes is maintaining an optimal blood glucose level. Controlled blood glucose levels helps to prevent diabetes related complications such as cardiovascular issues, neuropathy, kidney failure, eye deterioration, and death. In order to manage blood glucose, individuals must have an understanding of nutrition, diet, and health. Objective: The objective of this project is to promote nutritional awareness and encourage low carbohydrate dieting among T2DM patients through interactive game based learning. Design: A convenience sample of 30 (N=30) was recruited to participate in the project. The quality improvement (QI) project used a pretest/posttest design to compare fundamental knowledge and willingness to improve lifestyle and diet after receiving diabetic nutritional education in the form of interactive gaming. Setting: The setting for this project was the Diabetes Management Center at P/SL in Denver, Colorado. Participants consisted of established patients at the Diabetes Management Center P/SL. Participants: A total of 30 participants were recruited as a convenient sample population, only 21 volunteers actually participated. Participants received a flyer from their clinician illustrating the projects requirements and purpose. Participants received detailed information from the PI regarding the project rules, outline, and disclosures. Criteria for inclusion included: (a) type two diabetic, (b) current patient (c) 18 years of age or older, and (d) English speaking regardless of whether it was their first language or a secondary language. Measurements: A pre and posttest questionnaire were completed via Qualtrics survey software. Participants first completed a pretest, then played the educational game. After gaming they completed a posttest survey. The pre and posttest consisted of the same 10 multiple-choice questions written at a 4th grade level; the questions pertained to low carbohydrate foods and healthy meal options. The posttest also included a 5-point Likert scale, the scale assessed participants likelihood to follow a low carbohydrate diet. Results: The PI provided 21 T2DM participants with a virtual educational game which illustrated low carbohydrate foods. Prior to gaming participants completed a pretest questionnaire, after gaming they completed a posttest questionnaire. All 21 participants completed the pretest, gaming intervention, and posttest survey for a participation rate of 100%. After participating in the QI project, 86% of participants verbalized an appreciation for the educational game. Of the 21 diabetics who participated, 16 participants (76%) felt more inclined to begin a low carbohydrate diet after participating in the Joslin Carbohydrate Challenge game. Conclusion: This project provided an overview of an innovative integrated gaming platform which combined technology with sensory motor education. The educational game provided insight into how interactive game based learning can be applied to the design of behavior change technology in health care. The findings from this QI project contribute to current knowledge regarding the development and testing of complex behavior change technologies in healthcare.