Games for Glucose
It was around 2007 when I came up with a solution to a very frustrating problem. My team at Diabetech had already designed and implemented what is still the easiest to use and most reliable way to upload blood sugar meter data. You can read up on the GlucoMON elsewhere.
This post is about a novel way to leverage data in changing behavior. As I said, we had made the data upload process as easy as possible. And, we were beginning to understand that it wasn't necessary to have the patient perform the upload step every day. A 5 second step every few days was starting to appear to be good enough for most uses. While my initial design for an automated diabetes management system required 'real-time' it turns out that this is only one way to use data and perhaps the least clinically important version.
Back to the problem... we had families in our studies who for whatever reason had a really hard time participating via the upload event; a 5 second task that required the user to connect their meter to a cable once a week. Even a 2 yr old could do this so you can imagine my frustration.
A phone call here and there worked as a request to connect but that's not fun for anyone and will prove to be an Achilles heel if and when large scale commercial adoption of remote glucose monitoring systems are to ever take off.
Enter a very simple game.
What if we used a computer program to generate a random number at the end of each day? The person who's data was uploaded earlier that day that matched or was closest to the random number would be declared the 'winner'. The winner would receive some kind of prize that would hopefully have a perceived value to the winner.
We tried this out and here's what we learned:
it was very easy to implement as a new software feature on our side
no behavior change was required of the patient; none, zero.
after contacting the first winner and securing their authorization to share their name and a photo with the other patients, we sent out an email to all study participants announcing the winner, what prize they chose and how the game worked.
we learned that kids are smart. Almost instantly the frequency of user connect events increased to almost daily vs. once every few days for most.
we also witnessed an increase in how many times per day the kids were checking their blood sugar. It seems that they figured out the more blood sugar checks the better their chances of winning.
And, the participant families loved the game regardless of whether or not they ever won. They said it was 'fun'.
We know through analysis of published research that increased blood sugar testing frequency is directly correlated with improved blood sugar control. Making diabetes management fun might seem like a stretch but why not try?
It's an understatement to call that feature (we called the game "Mystery BGee") a successful data-enabled intervention within the realm of digital health.
Since then, more than seven years ago, I've only seen a few attempts at 'gamification' in diabetes. These are typically patient intensive activities that require exponentially more time and effort. It also usually involves some kind of points scheme that takes place over extended timeframes. I don't know which approach is better but I typically side with those things which are easiest for the patient to do. Mystery BGee was drop dead easy for the patient to do.
So why aren't there more 'games' in diabetes or even attempts at making it fun? Your thoughts are appreciated as always.