The idea of gamification in diabetes management has been around since Merck developed the Type 2 Travelers Project back in 2013. However, low user retention has bedevilled many smart-phone diabetes apps. Meanwhile, incidence of the disease is predicted to keep growing, with a prevalence of over 12% in adult populations by 2040. Predicted rather than certain, because it’s not currently clear what the long-term impact of GLP-1 drugs will be, especially as expensive injections get replaced by more affordable tablets.
Created to support adherence to medication and sustainable lifestyle changes, Merck’s original app took users through a series of games in which they collected credits to move their avatars around the world, with an online community of diabetes sufferers to promote engagement and enhance retention, motivation and inspiration.
An element of interaction is key to improving retention rates in the gamification of diabetes management. Interactive features in disease-management apps encourage sustained use by empowering patients to proactively manage their diabetes, cultivate positive behaviours and support their mental health. In short, online and off-line interaction can drive behavioural change and lead to better outcomes.
Certain apps have sought to take advantage of interaction within families to better manage diabetes and improve outcomes. High drop-out rates, affecting almost one-third of diabetes app users, have been a significant challenge. However, AI-driven apps can overcome this by improving medical insights, increasing retention, and ultimately enhancing clinical outcomes.
But the big question remains: are subscribers to these apps simply a self-selected group of patients pre-disposed to be motivated to change? Or can any diabetic be persuaded to adapt their lifestyle in the right environment?
Diabetes gamification: improving engagement and retention
The last decade has seen growing interest in harnessing interactive technology to bring about better disease self-management and education among patients.
Successful gamification often depends on creating multi-disciplinary teams of endocrinologists and diabetologists, medical-informatics experts and, of course, experienced game designers. In these apps, users earn credits for healthy lifestyle choices and are debited for poor choices. As one research paper notes, “this gamified approach aims to reinforce positive behaviours and provide immediate feedback on negative ones. Interactive animations confirm or deny options selected by the player, further enhancing the learning experience”.
But while digital therapeutics can almost certainly help with diabetes remission, an app dropout rate of nearly 30% in clinical trials is clearly problematic. Various studies show how AI-driven apps could reverse these low user-retention rates in smartphone diabetes tools by taking on board the importance of online interaction and gamification while leveraging the dynamics of family groups.
As various academic studies on gamification have noted, no diabetes intervention has yet leveraged real-time interactions between patients and family members. However, there is huge potential for AI-driven interaction within families to address attitude, motivation and mental health issues. Improvements here will lead to better retention and better outcomes.
We know from experience and research that patients’ families can play a crucial role in managing diabetes. Pharmaceutical giant Merck points out that family involvement encourages diabetes sufferers to lead healthier lifestyles.
The aim of involving family members springs from a need to make diabetes-management apps more appealing to a broader range of patients who have not yet been motivated to change their lifestyles. Harnessing AI within family groups to build knowledge, motivation and encouragement through gamified apps with personalised nudges, dynamic monitoring and readily available advice could create the right environment to achieve this. In short, something that works for everybody.
AI-driven technology can offer tailored suggestions and strategies, helping a patient’s family understand the importance and intricacies of diabetes management, interpret medical data, and receive advice on how to help patients. If that advice is concise, personalised to their particular needs and readily available in an app, users are more likely to treat such apps as crucial tools in maintaining the motivation to lower blood-sugar levels and choose healthier lifestyle options.
Helping more patients into remission: other approaches
It’s worth remembering that AI-driven gamification apps are not the only diabetes management solution. For example, GluCare’s hybrid VIP service has seen impressive results, with the first data released since launch in 2020 showing that the hybrid approach of in-clinic and remote monitoring has achieved an impressive reduction of 1.7% in HbA1c levels regardless of baseline within the first 90 days.
As Glucare explains, and as various studies affirm, “HbA1c is a key measure of how well controlled one’s blood sugar has been on average over a three-month period… A reduction of just 1% point in HbA1c results in a 21% decrease in end-point diseases related to diabetes, a 21% reduction in diabetes-related deaths, a 14% decrease in heart attacks, and a 37% reduction in microvascular complications.”
GluCare notes the importance of weight loss for diabetes remission. It lists more than 40 parameters relevant to a patient’s metabolism, and its service includes close monitoring of them all. “More information”, says GluCare, “means better insights and better result for achieving remission in type 2 diabetes”. When combined with its data-monitoring service from user and its AI tools, better insights will lead to better outcomes for more patients.
Breathe Well-being’s Diabetes Reversal Program (BDRP) offers users a tailored lifestyle-management platform that incorporates an element of coaching on diet and exercise in addition to monitoring blood-sugar levels, weight and physical exercise.
Breathe Wellbeing has supported 25,000 patients, 70% of whom have gone into remission, and around 90% of patients have demonstrated reduced reliance on medication after an average weight loss of 5.5kg. Studies on the app’s success in India show that levels of glycated haemoglobin or HbA1c, a measure indicating blood-sugar levels over the previous 3 months, dropped in over 80% of patients after a 19-month treatment period.
Compared to the study’s control group – with patients taking only physician-prescribed diabetes medicine – medication withdrawal was observed in around 90% of patients after one year, and this was sustained for at least a further six months.
Better insights
The integration of AI and gamification into diabetes-management apps can significantly enhance engagement and bring about changes in lifestyle choices. After all, there are roughly 450 million people worldwide suffering from the condition, 90% of them having type-2 diabetes. But it’s by no means a comprehensive solution. A hybrid approach that incorporates AI-driven gamification and in-clinic treatment can deliver impressive results, and as the healthcare industry explores new ways to harness the power of AI to gain greater insights into a patient’s health, there’s a real opportunity to revolutionise diabetes treatment, thereby increasing remission, improving patients’ quality of life and driving down death rates.
