OBJECTIVE Rigorous evidence is lacking whether online games can improve patients’ longer-term health outcomes. We investigated whether an online team-based game delivering diabetes self-management education (DSME) to patients via e-mail or mobile application (app) can generate longer-term improvements in hemoglobin A1c (HbA1c). RESEARCH DESIGN AND METHODS Patients ( n = 456) on oral diabetes medications with HbA1c ≥58 mmol/mol were randomly assigned between a DSME game (with a civics booklet) and a civics game (with a DSME booklet). The 6-month games sent two questions twice weekly via e-mail or mobile app. Participants accrued points based on performance, with scores posted on leaderboards. Winning teams and individuals received modest financial rewards. Our primary outcome measure was HbA1c change over 12 months. RESULTS DSME game patients had significantly greater HbA1c reductions over 12 months than civics game patients (−8 mmol/mol [95% CI −10 to −7] and −5 mmol/mol [95% CI −7 to −3], respectively; P = 0.048). HbA1c reductions were greater among patients with baseline HbA1c >75 mmol/mol: −16 mmol/mol [95% CI −21 to −12] and −9 mmol/mol [95% CI −14 to −5] for DSME and civics game patients, respectively; P = 0.031. CONCLUSIONS Patients with diabetes who were randomized to an online game delivering DSME demonstrated sustained and meaningful HbA1c improvements. Among patients with poorly controlled diabetes, the DSME game reduced HbA1c by a magnitude comparable to starting a new diabetes medication. Online games may be a scalable approach to improve outcomes among geographically dispersed patients with diabetes and other chronic diseases.

中文翻译：

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基于团队的在线游戏可改善2型糖尿病退伍军人的血糖控制：一项随机对照试验

目的缺乏可靠的证据来证明在线游戏是否可以改善患者的长期健康状况。我们调查了通过基于团队的在线游戏通过电子邮件或移动应用程序向患者提供糖尿病自我管理教育（DSME）能否对血红蛋白A1c（HbA1c）产生长期改善。研究设计和方法将HbA1c≥58 mmol / mol口服糖尿病药物的患者（n = 456）随机分配到DSME游戏（带公民手册）和公民游戏（带DSME手册）之间。历时6个月的游戏每周两次通过电子邮件或移动应用发送两个问题。参加者根据表现获得积分，分数发布在排行榜上。获胜团队和个人获得的经济奖励不高。我们的主要结局指标是12个月内HbA1c的变化。结果DSME游戏患者在12个月内HbA1c的降低显着大于公民游戏患者（分别为-8 mmol / mol [95％CI -10至-7]和-5 mmol / mol [95％CI -7至-3]。 ； P = 0.048）。在基线HbA1c> 75 mmol / mol的患者中，HbA1c的降低更大：DSME和公民的-16 mmol / mol [95％CI -21至-12]和-9 mmol / mol [95％CI -14至-5]游戏患者，分别；P ＝ 0.031。结论随机分配到提供DSME的在线游戏的糖尿病患者表现出持续且有意义的HbA1c改善。在糖尿病控制不佳的患者中，DSME博弈将HbA1c降低的程度可与开始新的糖尿病药物媲美。在线游戏可能是一种可扩展的方法，可以改善地理位置分散的糖尿病和其他慢性病患者的治疗效果。