by Mary Lynn Lyke. Republished from the iSchool's iNews newsletter.

Video games may be good for hand-eye coordination, strategizing, skill building and pitting interplanetary forces of good against evil. But can they make America a healthier society?

That’s the bet of an increasing number of U.S. health-care advocates who are helping to create innovative, interactive games that empower patients with medical knowledge and self-care techniques.

Leading the way at the University of Washington are researchers from information, medical and health service fields who’ve teamed up to create video games designed to help people with diabetes master nutritional skills and manage blood sugars.

Can you guess the carb count of a Big Mac? Compare the caloric density of an apple and a banana? Proceed to the next level.

"Diabetic patients really can be in control of their disease, can take ownership of the disease and master it themselves. But first we have to give them the tools to help them understand it," says the project’s principal investigator Wanda Pratt, associate professor in both the University of Washington Information School and the Division of Biomedical and Health Informatics in the Medical School.

The $200,000 gaming project, one of the first in the country to help adult diabetics manage diet in a nontraditional way, is funded by the Robert Wood Johnson Foundation (www.healthgamesresearch.org). The foundation is supporting a dozen exciting new health game research projects across the country, including alternate reality games that teach substance abusers skills to prevent real-world relapses, computer-training programs that use Wii technology to help Parkinson’s patients with balance and a breath biofeedback game for kids with cystic fibrosis.

The call for alternative approaches to chronic disease control comes at a time when diabetes rates are surging across the country. Centers for Disease Control and Prevention statistics show that the rate of diabetes cases has nearly doubled in the last ten years. Roughly 90 percent of the new cases are Type 2 diabetes, a disease that typically presents later in life and is tied to rising obesity in America, the Fast Food Nation.

Over time, approximately one quarter of Type 2 patients control the disease with diet, half take oral medications and another quarter are insulin-dependent.

Pratt understands the difficulties of dealing with the complicated disease. She grew up with a grandmother who struggled every day with her Type 2, insulin-dependent diabetes. She remembers the guilt her grandmother felt every time she had a small piece of cookie, pie or the mashed potatoes she loved so much. "It was almost a sin for her, something she was not supposed to do," says Pratt.

"That approach is hard on people’s lives. Studies show that they tend to revert—if they can’t do what they’re supposed to do, then why are they even trying? Some give up altogether."

The consequences of giving up can be life-threatening: as the disease progresses, eyesight can fade, organs can fail, limbs can turn lifeless and ulcerate.

Controlled trials show diabetic patients who are able to manage their blood sugars can decrease the likelihood of these complications. Even modest changes in diet, exercise and weight loss have substantial impact on insulin sensitivity.

Yet studies show that only two in five persons with diabetes are able to keep their blood sugars in an appropriate range.

It’s "hard work," say patients. In online chat rooms, they talk about having to count carbs and calories, monitor pills and insulin, continually test glucose and try to control the soaring, diving blood-sugar levels that can leave them sweaty, shaky, confused, or flat on the floor, passed out. Some talk about getting "crazy hungry" for foods that aren’t good for them. "I must not slip into the old habit of pigging out on junk food," writes one diabetic in a discussion forum.

Although new rapid-acting insulin analogues allow these modern-day diabetic patients greater freedom and flexibility in what they eat, they still have to have a sophisticated understanding of the relationship between glucose and diet to make the right choices.

Many complain it’s up to them to do all the work.

And they may be right.

"Diabetes is a 24/7 disease," says Dr. Dace Trence, director of the UW’s Diabetes Care Center and Endocrinology Fellowship Program, and a co-investigator of the gaming study. "No physician, no registered dietitian, no nurse educator could be with a patient all the time to help with meal choice, medication dosing, treating a high or low blood sugar. The patient has to ‘steer the ship.'"

Pratt’s graduate research assistant Lynne Harris, who spearheaded the initiative to take diabetes education into the gaming world, witnessed the struggles patients face from inside the UW Diabetes Care Center.

"Initially, before development began, I talked to clinicians at the UW Diabetes Care Center and sat in on office visits. That was important for me. I don’t have diabetes, never had to live with it, and I got to hear the experiences of patients and see their day-to-day challenges," says Harris, a doctoral candidate in the Department of Health Services and a master’s student in the Division of Biomedical and Health Informatics.

Hearing health-care providers quiz patients about what, exactly, they’d had for lunch and snacks several days before was illuminating for Harris. "Me, I might remember what I had for breakfast—but three days ago at lunch? It showed me that if clinicians rely on dietary recall, it’s clearly not an ideal system."

If memory and memorization are problematic, what can video games add to the education process?

Research shows nearly half of all adults play video games, and adults comprise the majority of the diabetic population. Yet most previous games relating to diabetes have been targeted at younger audiences.

The UW’s study focuses on adults, and relies on the aging baby boomer’s preferred form of online gaming—the "casual game" genre that includes favorites such as Tetris, Solitaire and Scrabble. The first Web-based games in development are "Fooduko," a takeoff on the number puzzle game Sudoku, and a trivia game called "Postcard."

At the web site researchers have dubbed "Foodle" (foodle.uwmedicine.org), patients will be able to play these games online, download mini-games to their mobile phones and participate in diabetes discussion forums.

The intent of the games is to help diabetic patients develop nutritional estimation and food comparison skills. As they play, gamers learn to make educated guesses about the carbohydrates and dietary energy density in the food images that pop up on their screen. Those skills can be invaluable to a diabetic reluctant to haul out nutritional reference books on restaurant dates or ask to see food labels at five-course dinner parties.