GAMES FOR HEALTH JOURNAL: Research, Development, and Clinical Applications

Volume 4, Number 5, 2015 Editorial

ª Mary Ann Liebert, Inc.
DOI: 10.1089/g4h.2015.0055

Diabetes Prevention and Management:

What Does a Serious Game Have to Do with It?

Laurie Ruggiero, PhD

D iabetes and one of its primary preventable risk fac-

tors, obesity, are dual public health challenges. Projec-
tions indicate that in the year 2035, 592 million adults
to enhance diabetes prevention or care. The response to this
call resulted in this special issue of G4HJ.
Prior reviews and a meta-analysis have described the
worldwide may have diabetes.1 Far-reaching and diverse promise of health games in general and particularly in
efforts are needed to reach people with and at risk of diabetes helping people with diabetes (see, for example, DeShazo
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to help reduce these growing problems. et al.,4 Lieberman,5 and DeSmet et al.6). This special issue
Diabetes is defined as ‘‘a chronic disease that occurs when expands on the literature with its inclusion of three interna-
the pancreas does not produce enough insulin, or when the tional articles covering diverse topics on the use of health
body cannot effectively use the insulin it produces,’’ leading games in diabetes-related areas. These articles include a
to elevated blood sugar (i.e., hyperglycemia); hyperglycemia systematic review of gamification in diabetes and descrip-
can lead to damage to many of the body’s systems over tions of two diabetes-related serious games, one focused on
time.2 Diabetes is associated with serious long-term com- teaching physicians about insulin use and one focused on
plications, such as eye, heart, and nerve diseases, kidney teaching adolescents about healthy eating. I will highlight
failure, stroke, and lower-limb amputations.3 each to pique your interest in reading the full articles.
Daily management of diabetes involves controlling blood The first article7 describes a pilot study that tested the
sugar levels, usually through medication and multiple lifestyle usability and playability of a serious game (i.e., ‘‘InsuOn-
or self-care activities, such as healthy eating, self-monitoring Line’’) for education of primary care physicians on insulin
of blood sugar levels, and getting regular physical activity. In therapy for patients with diabetes mellitus. In addition to
addition, for people with diabetes, weight loss is key when describing an exciting game, this article highlights the use of
they are overweight or obese; smoking cessation is critical for a multidisciplinary development team in game development,
smokers; and other preventative behaviors, such as foot care the value of theory in guiding game development, and the
and eye exams, are important to prevent or lower the risk of importance of formative feasibility and usability testing with
long-term complications.2,3 As is hopefully evident, diabetes users to help refine a game. To find out more about this
self-management (and prevention) requires the individual to innovative game and the lessons learned in this study, read
engage in multiple complex behaviors, generally on a daily the complete article by Diehl et al.7
basis. The second study is by Marchetti et al.8 and entitled
Broad, diverse, and innovative efforts are needed to sup- ‘‘Preventing adolescents’ diabesity: Design, development,
port the prevention and management of diabetes. Game and first evaluation of ‘Gustavo in Gnam’s Planet.’’’ If the
developers and game researchers can play an important role title alone doesn’t make you curious, let me share that this
in addressing these public health challenges. In particular, study focuses on the development and evaluation of an
they might develop fun, engaging, convenient strategies exciting health game designed to improve knowledge
that can reach large populations of people with or at risk about and consumption of healthy foods in adolescents.
of diabetes to effectively provide knowledge, build skills, The development of this game was guided by theory and a
enhance confidence, and increase motivation to success- multidisciplinary team composed of both ‘‘fun-ness’’ and
fully engage in lifestyle and self-care behaviors to help lose ‘‘serious-ness’’ professionals.9 Read this article to learn
weight and/or manage diabetes. In addition, they might more about the development of ‘‘Gustavo in Gnam’s Plan-
create serious, but fun, games to help educate healthcare et,’’ the results of the pre–post evaluation of its impact on
providers or families of children with diabetes about this knowledge and behavior change, and the important lessons
disease and its treatment. They could also create games to learned in this study.
help youth learn about healthy eating and physical activity The third article is a systematic review of published lit-
to support efforts to prevent obesity. The need is great, and erature on the use of videogames, gamification, and virtual
the ideas can be limitless. environments in the self-management of diabetes. In this
The Games for Health Journal (G4HJ) shone a spotlight article, Theng et al.10 identified 307 relevant studies and
on this topic, by issuing a call for articles on the use of games provided a detailed review of 10 studies that met their

Institute for Health Research and Policy, Community Health Sciences, School of Public Health, University of Illinois at Chicago,
Chicago, Illinois.

333
 334 EDITORIAL

inclusion criteria. Read this informative systematic review 3. Centers for Diabetes Control and Prevention. National di-
to learn more about these 10 studies, the challenges abetes statistics report: Estimates of diabetes and its burden
identified in the prior work on this topic, and the authors’ in the United States, 2014. www.cdc.gov/diabetes/pubs/
recommendations for future research in this area. statsreport14/national-diabetes-report-web.pdf (accessed
As highlighted in these three articles,7,8,10 games offer July 21, 2015).
promise in supporting clinicians and people with and at risk 4. DeShazo J, Harris L, Pratt W. Effective intervention or
for diabetes. However, more research is needed to better child’s play? A review of video games for diabetes edu-
understand the critical components that are needed to de- cation. Diabetes Technol Ther 2010; 12:815–822.
velop and deliver an effective health game that facilitates 5. Lieberman D. Video games for diabetes self-management:
behavior change. Some suggested strategies from our three Examples and design strategies. J Diabetes Sci Technol
2012; 6:802–806.
articles include working with a diverse development team
6. DeSmet A, Van Rycheghem D, Compenolle S, et al. A
bringing together experts in diabetes content, game theory
meta-analysis of serious digital games for healthy lifestyle
and development, the lived diabetes experience, and be- promotion. Prev Med 2014; 69:95–107.
havior change, among other areas. As noted in the systematic 7. Diehl LA, Souza RM, Gordan PA, et al. User assessment of
review by Theng et al.,10 larger sample sizes and stronger ‘‘InsuOnLine,’’ a game to fight clinical inertia in diabetes:
experimental designs are needed to show strong evidence A pilot study. Games Health J 2015; 4:335–343.
for the effectiveness of diabetes-related health games. 8. Marchetti D, Fraticelli F, Polcini F, et al. Preventing ado-
We can help move the field forward by subjecting our games lescents’ diabesity: Design, development, and first evalua-
to rigorous scientific study, such as using randomized con- tion of ‘‘Gustavo in Gnam’s Planet.’’ Games Health J 2015;
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trolled designs, to help convince others that we are not ‘‘just 4:344–351.
playing games’’ but are offering alternative innovative 9. Baranowski T, Buday R, Thompson D, et al. Developing
engaging and convenient ways to reach people to provide games for health behavior change: Getting started. Games
information, skills, confidence, and motivation to change Health J 2013; 2:183–190.
behaviors related to diabetes prevention and management. 10. Theng Y-L, Lee JWY, Patinadan PV, Foo SSB. The use of
The Editor of G4H and I hope this issue will reinforce your videogames, gamification, and virtual environments in the
enthusiasm if you are already focused on the prevention or self-management of diabetes: A systematic review of evi-
management of diabetes using health games. If you have not dence. Games Health J 2015; 4:352–361.
worked in this area before, we hope this issue leaves you
thinking, ‘‘I have a great idea for a health game that may Address correspondence to:
help.’’ We both look forward to reading more about your Laurie Ruggiero, PhD
innovative work in future issues. Institute for Health Research and Policy
Community Health Sciences
References School of Public Health
University of Illinois at Chicago
1. International Diabetes Federation. IDF Diabetes Atlas, 6th MC275
ed. Brussels: International Diabetes Federation, 2014. 1747 West Roosevelt Road
2. World Health Organization. Diabetes Fact Sheet 2015. Chicago, IL 60608
www.who.int/mediacentre/factsheets/fs312/en/ (accessed
July 21, 2015). E-mail: lruggier@uic.edu