Games serious new tools in diabetes care

Video games may be good for hand-eye coordination, strategizing, skill-building and pitting interplanetary forces of good against evil. But can they make the United States 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 ( The foundation is supporting a dozen exciting new health game research projects across the country.

Centers for Disease Control and Prevention statistics show that the rate of diabetic 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 the U.S.

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

Many diabetics experience difficulties dealing with the complicated disease. The consequences of giving up can be life-threatening: as the disease progress, 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.

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

"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 on 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.

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.

At the Web site researchers have dubbed "Foodle" (, 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.

If testing shows the games are beneficial, they'll be released online to the public, through the UW's medical system, various diabetes associations, and HealthVault, a free online service from Microsoft which provided additional support for the project. Positive returns could spur larger-scale controlled trials that target different diabetic populations, including children and the disadvantaged.

Pratt says she hopes the study will be taken seriously, and will ultimately increase the effectiveness of future health games.

Adding a little fun to the equation might just be the ticket.