Virtual Games for diabetic children - ILAMI Conference 9-June-2014

Interactive Games for Increasing Compliance of Chronic Patients

A Virtual World for Children with Diabetes

Ofer AtzmonBusiness Development Advisor, [email protected]

Moran Shemesh-Iron - Psychologist, Schneider Medical Center

Nessia Nagelberg - Rehabilitative Psychologist, Schneider Medical Center

9 June 2014Makomba - Virtual World for Children with Diabetes1

mailto:[email protected]

Agenda

• The Development Team• Diabetes Type I – The Implications• The Advantages of Games• The Game Environment• The Clinical Trial• Outcomes and Conclusions


The Development Team

• Schneider Children’s Medical Center • Clinical and psychological knowledge • Clinical tests

• Compedia• Co-finance• Gamification and gaming technologies• Software development

• Intel Israel • Financial support• Contribute laptops


About Schneider Medical Center

The Institute of Endocrinology & Diabetes, National Center for Childhood Diabetes

• One of the largest type 1 diabetes clinics in the world

• 17,000 out-patients a year, 1,700 patients with type 1 diabetes

• Multidisciplinary team approach which includes: physicians, nurses, dietitians, psychologists and social workers

• Psycho-social team includes 6 psychologists and social workers

• Median HbA1C is lower then international average


• Schneider’s median HbA1C is 7.8% (2011)• International median: 8.2%• Recommended median: 7.5%

About Compedia • Twenty-five years experience in gaming and gamification

• Focus on education and healthcare

• 35+ languages, 50+ markets, 10M units sold

• High level of R&D; dozens of awards

• Cross platform: PC, MAC, iPhone, iPad, Android

• R&D cooperation with leading corporations, research

centers and universities


Areas of Compedia’s Activity• Educational & digital learning systems

• Engagement & reward systems

• Learning management systems

• Adaptive learning and content development

• Sensors integrated systems

• Virtual learning environments and simulations

• Augmented reality (AR) platform for training and applications

• eHealth software systems:

• For children with diabetes

• For children with autism


Type 1 Diabetics: The Problem


• 1 in 400 children has type 1 diabetes

• Will double in the next 20 years

• No known cure

• The pancreas does not produce enough insulin, a hormone that regulates blood sugar

• Require daily management of insulin for glycemic balance

• Self-management, education and training are critical for improving outcomes and quality of life

• Intensive insulin therapy reduces the risk of cardiovascular disease

• National burden of disease (USA, 2012): $245 billion


A Novel Solution: Games for Health

8

• Games for health are a growing area of interest

• Inform and teach patients and families about proper care

• Turn a routine unpleasant process into fun

• Improve knowledge and adherence

• Save costs, improve outcomes

• Learning by trial and error, without “paying” for mistakes

• Gamification could revolutionize healthcare industry

• Particularly effective for children

The Makomba Environment


• Life-simulating virtual environment

• Specific diabetes learning

• Variety of fun games and learning activities

• Multiuser activities & safe social networking

Makomba: The Movie


https://www.youtube.com/watch?v=rKbdJQ-mDdg




The Avatar

• Each child has his own Avatar (character) which has diabetes

• The child customizes his Avatar

• The child has to take care of his Avatar’s diabetes while performing daily activities

• The Avatar’s blood glucose levels change during the day

Data Collection


• Integration of blood glucometer – including data upload

• Monitoring and management tools for caregivers

• Helping the therapists to monitor, control and treat


Fun Learning Activities• Many fun games distracting children’s attention away

from their condition

• Disease related knowledge games

• Data on user progress is uploaded to the web

• Personalized and adjusted to each patient

Social Interaction


• Multi-user activities

• Group sharing and morel support

• Safe and secure private network

• Social support group

Encouraging involvement


• Rewards (virtual and tangible)

• Designing a personal home

• Hall of Fame


Advantages of the System

• Overcoming psychological resistance

• Real engaging environment

• Support & motivation via social networking & multiuser activities

• Enabling rules-based recommendations and alerts

• Collecting data helps therapists to treat and control

• Caregivers’ system for monitoring & mission assignment

• Integration of a blood glucometer

• Cross platform

Testing the Impact• 30 children assigned to study and control group in 2:1 ratio

• Children in the study group were provided with Makomba installed on an Intel® Classmate PC for a 3 months period

• Inclusion Criteria: Type 1 diabetes diagnosed at least one year prior to study entry, ages 7-11 years

• Treatment either with CSII (pump) or MDI (injections), HbA1c > 8.0%


Study Outcomes

• Playing time:

• Average playing time was 15 ± 8.6 hours/3 months (range from 1.2 - 32.1 hours)

• 50% of the children played > 13 hours

• Clinical/Psychological outcomes:

• Playing Makomba improved Quality of Life of the study group

• Study group doubled their Diabetes Knowledge

• Study group showed a higher effect size in metabolic control compared with the control group


Quality of Life Results• Improvement in quality of life (PedsQL) in study group

was found to be significant compared to control group


0

20

40

60

80

100

120

physical emotional Social school psychosocial Total

study control

P<.01 P<.01 P<.01 P<.01

Knowledge Test & Results

• Measures basic diabetes knowledge

• Multiple-choice questions

• % of children who responded correctly to all questions:


Study Group (N=17) Control Group (N=10)

Base line 17.6% 20%

After 3 months 52.9% 20%

Median HbA1C Results


8.25

8.3

8.35

8.4

8.45

8.5

8.55

8.6

8.65

8.7

8.75

study control

base line after 3 months

Cohen’s d= 0.75

Cohen’s d= 0.2

Cohen's d : Effect Size Index is calculated by dividing the difference in medians for the two groups by the SD

Conclusions

• Living with diabetes in the fantasy world improves management of diabetes in the real world

• Virtual games have significant potential to improve compliance, knowledge and clinical outcomes


Future Developments


• Integration with glucometers and insulin pumps systems

• Integration with eHealth systems for homecare

• Target additional users groups and ages

• Expand scope of clinical trials

• Develop virtual games for other chronic conditions

Summary – Lessons Learned

• Makomba virtual system aims at improving compliance and metabolic control for children with diabetes

• Main advantages:

• Overcoming psychological resistance

• Learning via Life-simulating environment

• Social networking

• Engagement system

• Integration of a blood glucometer

• Monitoring and intervention tools for caregivers

• Promising potential for additional healthcare segments


Thank you תודה רבה

Ofer AtzmonBusiness Development [email protected]

Additional information and video:www.Makomba.nethttp://www.youtube.com/watch?v=rKbdJQ-mDdg


mailto:[email protected]

http://www.makomba.net/

http://www.youtube.com/watch?v=rKbdJQ-mDdg

Virtual Games for diabetic children - ILAMI Conference 9-June-2014

Healthcare