title: Impact of a Serious Videogame Designed for Flexible Insulin Therapy on the Knowledge and Behaviors of Children with Type 1 Diabetes: The LUDIDIAB Pilot Study.
abstract: BACKGROUND
  Flexible (or functional) insulin therapy method is a self-management education approach for intensive insulin therapy in patients with type 1 diabetes. The serious game (or applied game) "L'Affaire Birman" ("Mr. Birman's File") (available at www.gluciweb.com ) was specifically designed as an educational tool for the flexible insulin therapy method. Its educational impact was evaluated in children with type 1 diabetes.
  
  
  METHODS
  This prospective multicenter pilot study evaluated the effect of this videogame on the therapeutic knowledge and behavior of children with type 1 diabetes. PedCarbQuiz (PCQ) and Diabetes Self-Management Profile (DSMP) questionnaires were used before (T0), immediately after (T1), and 6 months after (T2) the unstructured use of the videogame.
  
  
  RESULTS
  The 38 children enrolled in the study were 42% boys and 58% girls; they had a mean age of 13.7 ± 2.1 years old, a diabetes duration of 6.0 ± 3.8 years, and hemoglobin A1c (HbA1c) levels of 8.5 ± 1.4% (69.4 ± 9.4 mmol/mol). The children connected to the game 3.3 ± 2.8 times during this 6-month study. Their PCQ score increased from 31.6 ± 4.9 at T0 to 36.0 ± 4.0 at T2 (P < 0.05). Two PCQ subscores also increased significantly: the insulin titration score at T1 and T2 and the carbohydrate quantification score at T2. Conversely, the DSMP score was not different at T0, T1, and T2 (59.1 ± 9.9, 60.2 ± 9.8, and 60.0 ± 10.0, respectively), and HbA1c levels also remained stable throughout the study (8.4 ± 1.3%, 8.4 ± 1.2%, and 8.5 ± 1.5% at T0, T1, and T2, respectively). Subgroup analysis found a greater impact of the game in children with poor glycemic control and low knowledge at baseline. Adherence to the game was rather low (half of the children played less than 2.5 bouts), but no criterion was found to be predictive of this low attractiveness.
  
  
  CONCLUSIONS
  Nonsupervised usage of the serious game "L'Affaire Birman" was able to improve insulin titration and carbohydrate quantification in children with type 1 diabetes.
authors.affiliation: 1 Diabetes Care, University Hospital of Caen , Caen, France .
authors.forename: Michael
authors.initials: M
authors.lastname: Joubert
authors.affiliation: 2 Pediatric Units, University Hospital of Caen , Caen, France .
authors.forename: Coline
authors.initials: C
authors.lastname: Armand
authors.affiliation: 1 Diabetes Care, University Hospital of Caen , Caen, France .
authors.forename: Julia
authors.initials: J
authors.lastname: Morera
authors.affiliation: 2 Pediatric Units, University Hospital of Caen , Caen, France .
authors.forename: Leyla
authors.initials: L
authors.lastname: Tokayeva
authors.affiliation: 3 Zippyware Company , Biarritz, France .
authors.forename: Aurore
authors.initials: A
authors.lastname: Guillaume
authors.affiliation: 1 Diabetes Care, University Hospital of Caen , Caen, France .
authors.forename: Yves
authors.initials: Y
authors.lastname: Reznik
mesh_terms: D000293:Adolescent; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000523:psychology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012648:Self Care / Q000379:methods / Q000523:psychology*; D011795:Surveys and Questionnaires; D018910:Video Games / Q000523:psychology*
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human