Review of Serious Games for People with Diabetes

Review of Serious Games for People with Diabetes

Alexandra Makhlysheva (University Hospital of North Norway, Norway), Eirik Årsand (University Hospital of North Norway, Norway) and Gunnar Hartvigsen (The Arctic University of Norway, Norway)
DOI: 10.4018/978-1-4666-9522-1.ch019
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This chapter aims to illuminate the current state of the field of diabetes-related serious games. First, it describes the problems and difficulties for young people with type 1 diabetes associated with their adherence to treatment regimens. The chapter also discusses various tendencies in the field of diabetes-related games that follow the findings of the systematic reviews performed between 2012 and 2014. Based on the reviews, significant gameplay features of games for health are identified. Further, it presents an example of a smartphone-based serious game developed for children with type 1 diabetes. Finally, this chapter discusses the distribution channel and platforms for serious games and improvements for the status of the field of games for health.
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Diabetes is one of the most common non-communicable diseases worldwide. In 2013, 382 million people had diabetes. This number could rise to 592 million by 2035 (International Diabetes Federation, 2013). The World Health Organization (World Health Organization, 2011), the World Diabetes Foundation (World Diabetes Foundation, 2014), and the International Diabetes Federation (International Diabetes Federation, 2013) characterize this development as an epidemic increase in prevalence of diabetes. There are many long-term diabetes complications, including heart disease and stroke, high blood pressure, retinopathy and blindness, kidney disease, neuropathy, and others (International Diabetes Federation, 2013). Moreover, according to the World Health Statistics report issued by the World Health Organization in 2004, diabetes was ranked the twelfth most common cause of death and could become the seventh leading cause of death by 2030 (World Health Organization, 2008).

Diabetes is rapidly increasing in children and adolescents in many countries. The International Diabetes Federation reports that there are about 490,000 children under 15 years old with type 1 diabetes worldwide (International Diabetes Federation, 2013). As only a small part of the global diabetes burden, with only 5%–15% of people with this form of the disease (, 2014), type 1 diabetes is the most prevalent form of diabetes in younger people (International Diabetes Federation, 2013). The number of children with type 1 diabetes rapidly increases annually: 78,000 children worldwide are newly diagnosed every year (TeensHealth, 2014).

Usually, financial costs for type 1 and type 2 diabetes are calculated together. However, type 1 diabetes entails the need for insulin therapy throughout one’s entire life, in addition to consultations with endocrinologists, physicians, diabetes nurses, dietitians, and possibly other specialists as well to manage the disease. Medical costs for type 1 diabetes in the U.S. have been estimated at $14.4 billion per year (Tao et al., 2010). In Australia, total costs for type 1 diabetes were estimated at $170 billion in 2011, which could double to $340 billion in the near future (Medical News Today, 2011). Solli and colleagues studied diabetes costs in Norway (Solli et al., 2010), and they reported a total cost of €293 million (both direct and indirect costs) in 2005 for disease management. Direct costs included €95 million for medication (€35.1 million for insulin and analogues), €48 million for disability pensions, €40 million for medical equipment expenditures, and €21 million for hospital stays. Indirect costs, such as sick leave due to diabetes, disability pensions, and basic and supplemental benefits related to diabetes amounted to €70.1 million. Thus, diabetes is a considerable burden for the whole world.

Diabetes is a very individual disease, where everyone experiences different reactions to food, physical activity, and medications. Therefore, the ways to handle the disease in daily life can also be very different. Children with diabetes usually have difficulties understanding their body’s reactions, the seriousness of the disease, and the importance of its treatment, which includes following particular guidelines for diabetes self-management. Sometimes, it can be difficult and frustrating for young children to accept the changes that type 1 diabetes entails, since the disease is a life-long disease.

Key Terms in this Chapter

Self-Management in Type 1 Diabetes: Includes a coordinated combination of regular blood glucose measurements (usually in the morning after wake-up), before and after meals (food intake increases blood glucose levels), before and after physical activity (as it decreases blood glucose levels), and before going to sleep, as well as carbohydrate counting and taking an appropriate amount of insulin.

Video Game: Is an electronic game that involves human interaction with a user interface to generate visual feedback on a video device. A video device is any type of display device that can produce two- or three-dimensional images, from large mainframe computers to small handheld devices.

HbA1c: Refers to glycated hemoglobin, which identifies the average plasma glucose concentration. When the body processes sugar, glucose in the bloodstream naturally attaches to hemoglobin. The amount of glucose that combines with this protein is directly proportional to the total amount of sugar in the blood at that time. Because red blood cells in the human body survive for 8 to 12 weeks before renewal, measuring HbA1c can be used to reflect average blood glucose levels over that duration, providing a useful longer-term gauge of blood glucose control. If one’s blood sugar levels have been high in recent weeks, the HbA1c will also be greater. Target HbA1c levels for a) people without diabetes are 4%–5.9%; b) people with diabetes are 6.5%; c) people with diabetes with a higher risk of hypoglycemia are 7.5% or higher. HbA1c levels between 5.7% and 6.4% indicate an increased risk of diabetes (pre-diabetes).

Diabetes Mellitus: Is a group of diseases characterized by high blood glucose levels, which is caused by defects in the body’s ability to produce and/or use insulin. Insulin is a hormone produced by the pancreas. It allows glucose absorbed from food to enter the body’s cells, where it should be converted into energy for muscles and tissues. In the case of diabetes, glucose continues to circulate in the blood and leads to hyperglycemia, which can cause serious damage to the body’s systems; it is especially harmful for the nerves and blood vessels. In the case of type 1 diabetes, the body’s immune system destroys the insulin-producing cells in the pancreas until there is little or no insulin left. Therefore, people with type 1 diabetes inject insulin.

Exergames: (Also known as active-playing video games) Are a category of games focused on physical activity, mostly played on Microsoft Kinect, PlayStation Move, Nintendo Wii, and other consoles. These games are based on a technology that tracks body movement and/or reactions to be used in the gameplay.

Serious Games: Are games designed for a primary purpose other than entertainment. They involve the use of electronic games technologies and methodologies and are meant to take on real-world problems. Entertainment and fun are usually used in such games to achieve the desired progress and/or learning by the player.

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