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Novak D. A Serious Game (MyDiabetic) to Support Children's Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study. JMIR Serious Games 2024; 12:e49478. [PMID: 38713496 PMCID: PMC11109855 DOI: 10.2196/49478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/24/2023] [Accepted: 02/13/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications. OBJECTIVE This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring. METHODS The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children's compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management. RESULTS The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game's impact on education, 1 week of testing revealed an enhancement in educational outcomes. CONCLUSIONS The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game's educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store.
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Affiliation(s)
- Daniel Novak
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Tatulashvili S, Dreves B, Meyer L, Cosson E, Joubert M. Carbohydrate counting knowledge and ambulatory glucose profile in persons living with type 1 diabetes. Diabetes Res Clin Pract 2024; 210:111592. [PMID: 38437987 DOI: 10.1016/j.diabres.2024.111592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/06/2024]
Abstract
CONTEXT The amount of consumed carbohydrates is the strongest factor influencing glucose levels during the four hours following a meal. Our aim was to evaluate the association between carbohydrate counting knowledge and continuous glucose monitoring (CGM) parameters in patients with type 1 diabetes (T1D) using different insulin regimens. METHOD In this multicenter prospective study, the GluciQuizz questionnaire was used to evaluate carbohydrate knowledge. CGM data for the 14 days preceding completion of the questionnaire were analyzed. The primary endpoint was evaluation of the correlation between the GluciQuizz total score and time in range (TIR) in the study population. RESULTS The mean age of the 170 participants was 40.7 ± 14.8 years and duration of T1D 18.8 ± 12.1 years. The mean GluciQuizz total score for all participants was 66 ± 13 %. Mean TIR was 58.6 ± 18.7 %. GluciQuizz total score positively correlated with TIR (r = 0.3001; p < 0.0001). This correlation was observed in CSII users (r = 0.2526; p < 0.05) but not in MDI (r = 0.2510; p = 0.1134) and HCL users (r = -0.1065; p = 0.4914). TIR was also negatively correlated with the mean carb count error in all study participants (r = -0.2317; p < 0.01). CONCLUSION In conclusion, as the Gluciquizz score was associated with metabolic control, this easy-to-use self-administered questionnaire could be used widely on a routine basis to assess the carbohydrate knowledge of T1D patients and to offer them targeted education tailored to their needs.
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Affiliation(s)
- Sopio Tatulashvili
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Sorbonne Paris Nord, CINFO, CRNH-IDF, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN); Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
| | | | | | - Emmanuel Cosson
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Avicenne Hospital, Université Sorbonne Paris Nord, CINFO, CRNH-IDF, Bobigny, France; Equipe de Recherche en Epidémiologie Nutritionnelle (EREN); Université Sorbonne Paris Nord and Université Paris Cité, INSERM, INRAE, CNAM, Center of Research in Epidemiology and StatisticS (CRESS), Bobigny, France
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Tandon A, Bhowmik E, Ali Z, Tripathi S, Bk A, Chen Y, Dabadghao P, Sudhanshu S, Bhatia V. Basic carbohydrate counting and glycemia in young people with type 1 diabetes in India: A randomized controlled trial. Nutrition 2024; 119:112318. [PMID: 38181475 DOI: 10.1016/j.nut.2023.112318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES The aim of this study was to evaluate the effect on glycemic control and acceptability of basic carbohydrate counting (BCC) in children and young adults with type 1 diabetes (T1DM). METHODS Ninety-two children and young adults (6-25 y of age) with T1DM were randomized to receive either routine nutrition education (RNE), which addressed food groups, glycemic index, and effects of food and exercise on glycemia, or learn BCC with personalized portion size education. A continuous glucose monitoring study and glycosylated hemoglobin (HbA1c) were performed at baseline and after 12 wk. The primary outcome was a change in time-in-range from baseline through 12 wk. A questionnaire on the acceptability of BCC was administered. RESULTS At 12 wk, there was no significant difference in change in time-in-range between the two groups (BCC group: 1.2 ± 12.2; RNE group: 1.9 ± 12.3; P = 0.786). No significant changes were observed in the percentage of time that blood glucose was >180 or >250 mg/dL; <70 or <54 mg/dL; glycemic variability, percentage of nights with hypoglycemia and HbA1c. In subgroup analysis, there was a significant decrease in HbA1c in the BCC group among participants with higher maternal education (-0.5 versus 0.2, P = 0.042). The total score on the acceptability questionnaire was higher in the BCC group (P = 0.022). CONCLUSION Among children and young adults in our region with T1DM, BCC provided flexibility in food choices and perception of greater ease of insulin adjustment. Although BCC was equivalent to RNE in terms of glycemic control, larger studies may reveal benefit in outcomes in certain subgroups.
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Affiliation(s)
- Ambica Tandon
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Eshita Bhowmik
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zebish Ali
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sarita Tripathi
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ajitha Bk
- Department of Statistics, Government Medical College, Thrissur, Kerala, India
| | - Yanjun Chen
- Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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Souza da Cunha LV, Carvalho Ramos Salles de Oliveira D, de Oliveira Cardoso L, Sartorelli DS, Xavier Peniche B, de Araujo BB, Luescher JL, Silverio RNC, Davalos A, Padilha PDC. The Association between Dietary Pattern, Obesity, and Glycemic Control of Children and Adolescents with Type 1 Diabetes Mellitus. Nutrients 2024; 16:364. [PMID: 38337649 PMCID: PMC10856978 DOI: 10.3390/nu16030364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/16/2024] [Accepted: 01/20/2024] [Indexed: 02/12/2024] Open
Abstract
AIMS To evaluate the association between dietary patterns, obesity, and glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS A cross-sectional study was carried out in 2015 at a diabetes reference center in Rio de Janeiro. Sociodemographic data and those related to outpatient follow-ups were obtained from the medical records. The assessment of food consumption was performed using a 24 h food recall. Obesity was defined as body mass index-for-age (BMI-for-age) ≥ +1 z-score. Glycemic control was assessed using glycated hemoglobin (HbA1c). Dietary patterns were generated by factorial analysis, and each individual's adherence to these dietary patterns was determined by the factor loadings and then classified into terciles. RESULTS The study population included 120 children and adolescents, among whom 5 dietary patterns were identified. The prevalence of obesity was 31.7% (n = 38), and 64.2% (n = 77) of the participants had inadequate glycemic control. We observed that individuals with higher adherence to dietary pattern five, characterized by a greater consumption of ultra-processed foods, had higher odds of having higher HbA1c levels (OR = 3.49; 95% CI = 1.18-11.16). CONCLUSIONS Higher consumption of ultra-processed foods can be detrimental to glycemic control in children and adolescents. Thus, food intake monitoring is of paramount importance as part of the multidisciplinary care of patients with T1DM.
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Affiliation(s)
- Letícia Victoria Souza da Cunha
- Instituto de Nutrição Josué de Castro (INJC/UFRJ), Rio de Janeiro 21941-590, Brazil; (L.V.S.d.C.); (B.X.P.); (B.B.d.A.); (R.N.C.S.)
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, Brazil;
| | - Dayan Carvalho Ramos Salles de Oliveira
- Fundação Oswaldo Cruz (FIOCRUZ), Escola Nacional de Saúde Pública (ENSP), Av. Brasil, 4365-Manguinhos, Rio de Janeiro 21040-360, Brazil; (D.C.R.S.d.O.); (L.d.O.C.)
| | - Leticia de Oliveira Cardoso
- Fundação Oswaldo Cruz (FIOCRUZ), Escola Nacional de Saúde Pública (ENSP), Av. Brasil, 4365-Manguinhos, Rio de Janeiro 21040-360, Brazil; (D.C.R.S.d.O.); (L.d.O.C.)
| | - Daniela Saes Sartorelli
- Departamento de Medicina Social, Faculdade de Medicina de Ribeirão Preto (FMRP), Universidade de São Paulo, Campus da USP—Cidade Universitária, Ribeirão Preto 14040-900, Brazil;
| | - Beatriz Xavier Peniche
- Instituto de Nutrição Josué de Castro (INJC/UFRJ), Rio de Janeiro 21941-590, Brazil; (L.V.S.d.C.); (B.X.P.); (B.B.d.A.); (R.N.C.S.)
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, Brazil;
| | - Beatriz Bastos de Araujo
- Instituto de Nutrição Josué de Castro (INJC/UFRJ), Rio de Janeiro 21941-590, Brazil; (L.V.S.d.C.); (B.X.P.); (B.B.d.A.); (R.N.C.S.)
| | - Jorge Luiz Luescher
- Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro 21941-590, Brazil;
| | - Raquel Nascimento Chanca Silverio
- Instituto de Nutrição Josué de Castro (INJC/UFRJ), Rio de Janeiro 21941-590, Brazil; (L.V.S.d.C.); (B.X.P.); (B.B.d.A.); (R.N.C.S.)
- Divisão de Alimentação e Nutrição (DAN), R. Prof. Marcos Waldemar de Freitas Reis s/n—Campus Gragoatá—São Domingos, Universidade Federal Fluminense (UFF), Niterói 24210-201, Brazil
| | - Alberto Davalos
- Instituto Madrilleño de Alimentación (IMDEA), Crta. de, Carr. de Canto Blanco, nº8, E, 28049 Madrid, Spain;
| | - Patricia de Carvalho Padilha
- Instituto de Nutrição Josué de Castro (INJC/UFRJ), Rio de Janeiro 21941-590, Brazil; (L.V.S.d.C.); (B.X.P.); (B.B.d.A.); (R.N.C.S.)
- Fundação Oswaldo Cruz (FIOCRUZ), Escola Nacional de Saúde Pública (ENSP), Av. Brasil, 4365-Manguinhos, Rio de Janeiro 21040-360, Brazil; (D.C.R.S.d.O.); (L.d.O.C.)
- Instituto Madrilleño de Alimentación (IMDEA), Crta. de, Carr. de Canto Blanco, nº8, E, 28049 Madrid, Spain;
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Wiyono L, Ghitha N, Clarisa D, Larasati A. Carbohydrate counting implementation on pediatric type 1 diabetes mellitus: systematic review and meta-analysis. Ann Pediatr Endocrinol Metab 2023; 28:206-214. [PMID: 37798895 PMCID: PMC10556441 DOI: 10.6065/apem.2244242.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/06/2023] [Accepted: 04/20/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Type 1 diabetes mellitus, which is the most common type of diabetes among children, is not curable but can be managed well without a negative effect on quality of life. One of the treatments of type 1 diabetes mellitus is carbohydrate counting. This systematic review and meta-analysis sought to evaluate the efficacy of carbohydrate counting with regard to hemoglobin A1c (HbA1c) reduction in children with type 1 diabetes mellitus. METHODS Nine studies were assessed, with the primary outcome being glycemic control (HbA1c changes). We searched the following electronic databases: ProQuest, PubMed, Scopus, and ScienceDirect. The quality of studies included was assessed using the risk of bias for randomized control trials and the JBI Critical Appraisal Checklist for observational and cross-sectional studies. Quantitative analyses were made and extrapolated into a forest plot. RESULTS A total of 1,693 articles were identified. Four reviewers independently screened titles and abstracts. Of the 36 articles screened, 34 articles were found to be eligible. Of these, 25 studies were excluded because of unsuitable outcomes and study designs. Nine articles were included in the final analysis. Meta-analysis showed that there was a reduction in HbA1c in the carbohydrate counting group as compared to the control group. The cumulative effect of carbohydrate counting on HbA1c was a mean difference of -0.55 (95% confidence interval, -0.81 to -0.28, P<0.001). All of the studies exhibited similar results with the mean difference reduction favoring the interventional group. However, the heterogeneity analysis revealed an I2 value of 88%, implying high heterogeneity in the meta-analysis. CONCLUSION The meta-analysis showed evidence favoring the use of carbohydrate counting in the management of type 1 diabetes mellitus.
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Affiliation(s)
- Lowilius Wiyono
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nida Ghitha
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dina Clarisa
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anjani Larasati
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Bawazeer NM, Alshehri LH, Alharbi NM, Alhazmi NA, Alrubaysh AF, Alkasser AR, Aburisheh KH. Evaluation of carbohydrate counting knowledge among individuals with type 1 diabetes mellitus in Saudi Arabia: a cross-sectional study. BMJ Nutr Prev Health 2022; 5:344-351. [PMID: 36619333 PMCID: PMC9813616 DOI: 10.1136/bmjnph-2022-000553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Carbohydrate counting (CC) is an important nutritional strategy to improve glycaemic outcomes among patients with diabetes. Few studies have investigated CC knowledge among individuals with type 1 diabetes mellitus (T1DM) in Saudi Arabia. Therefore, we aimed to evaluate CC knowledge in Saudi adults with T1DM. Study design and methods A cross-sectional study was conducted between December 2021 and February 2022, including 224 patients with T1DM from the University Diabetes Center, Riyadh. Adults aged ≥18 years, diagnosed with T1DM for >1 year, and residing in Saudi Arabia were included. CC knowledge was assessed using a previously well-studied tool (AdultCarbQuiz), which was translated into Arabic and tested for validity by a group of dieticians. Descriptive statistics were used for data analysis, and bivariate and regression analyses were conducted. Results The AdultCarbQuiz questionnaire-Arabic version had good validity and reliability (Cronbach's α: 0.87). The CC method was used by 54% of the participants. The mean CC knowledge score was 23.01±7.31. A significant negative linear relationship between the participants' CC knowledge scores, and age and glycated haemoglobin (HbA1c) levels, was revealed by simple regression analysis. Furthermore, significant independent variables related to CC knowledge scores were CC use, HbA1c levels, being taught about CC (>5 times), insulin pump usage and DM duration (≤15 years). Conclusions Approximately half of the patients used the CC method. The mean CC knowledge scores were better in patients who used the CC method, were more frequently taught about CC, were treated using an insulin pump, and had a shorter DM duration than their counterparts. Therefore, designing and implementing a well-structured nutrition education programme tailored to individuals with diabetes is crucial to provide them with up-to-date dietary information, as well as the necessary knowledge and skills, to improve their outcomes and manage their condition.
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Affiliation(s)
- Nahla Mohammed Bawazeer
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Leena Hamdan Alshehri
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Nouf Mohammed Alharbi
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Noha Abdulaziz Alhazmi
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Alhanouf Fahad Alrubaysh
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Alia Riad Alkasser
- Clinical Nutrition Program, Department of Health Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
| | - Khaled Hani Aburisheh
- University Diabetes Center, King Saud University Medical City, King Saud University College of Medicine, Riyadh, Saudi Arabia
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