Vikram Kumar has invented DiaBetNet, a computer game for children with type 1 diabetes. The goal is to motivate children to understand the disease and manage it.

A medical student in the Harvard-MIT Division of Health Sciences and Technology, Kumar developed the game working with MIT Prof. Alex Pentland and physicians at the Joslin Diabetes Center in Boston. Last summer, Joslin’s Dr. Lori Laffel led a clinical trial to test the new technology. Forty children, ages 8-16, took part.

“Often kids are embarrassed about having diabetes and don’t like other kids to know about it,” says Alison Tovar, a Joslin research assistant who worked with the children and their parents. “But here they were telling us that their friends thought DiaBetNet was really cool and that it was a lot of fun to play. To hear a kid say that anything about diabetes is fun is amazing.”

DiaBetNet is a guessing game. Children enter what they estimate to be their current blood glucose level on a handheld computer, and then check the level on a specially designed blood glucose meter that wirelessly transmits the result to the handheld. The handheld then awards the kids points based on how closely they guess.

But the real object of the game, says Kumar, goes far beyond simply teaching the kids to be good guessers. “We wanted to see if the game would encourage kids to start paying closer attention and help them see how they could achieve better control; therefore, we designed the game with some prerequisites.”

Before kids could play, they had to have checked their blood glucose three times that day, Kumar explains. They also had to have entered into the handheld not only those earlier glucose readings but also the amount of carbohydrates they had eaten during the day and the amount of insulin they had taken. “When they get ready to check their glucose level the fourth time and play the game,” Kumar says, “the handheld takes all that data and gives them a graph so they can begin to see patterns emerge and guess what their level might be now.”

Autoimmune Disease

Type 1 diabetes is an autoimmune disease that most commonly occurs in children and young adults. The body no longer produces insulin, so patients must inject the hormone several times daily and carefully control when and how much they eat. (The more common type 2 diabetes is a different disease that usually occurs in overweight adults.)

To help avoid abnormal blood glucose levels – those that are too high or too low can both lead to dangerous or life-threatening complications – type 1 diabetics also must test these levels frequently. “We see type 1 kids in the hospital all the time who just say, ‘I’ve had enough of this,’ and give up,” says Kumar. “I wanted to see if I could find a way to motivate them to improve their understanding so it would be easier for them to take control.”

For the DiaBetNet trial, the Joslin randomly assigned the children to either the game group or the control group. Children in both groups were given the new glucometer and handheld, but only those in the game group could play DiaBetNet. Since they weren’t playing the game, the children in the other group weren’t asked to check their glucose levels a specific number of times a day. “The number of times they checked was based on their own motivation,” Kumar explains.

At the end of the four weeks, the data showed that DiaBetNet had achieved its goals. “Children in the game group not only checked their glucose levels more often, but they also were more likely to keep participating in the trial,” says Kumar. “And we even found that they had fewer high blood sugars.”

Kumar’s passion is to help people with serious chronic diseases stay out of the hospital, so with several MIT colleagues he has started a company called Dimagi, which is dedicated to creating low-cost home-based technologies that make it easier for people to manage these conditions. Dimagi now is developing Dia- BetNet further and working with the Joslin doctors to mount a more extensive trial.

“Patients are going to have to live with type 1 diabetes until we come up with a way to cure it,” says Kumar. “We have to find systems that fit into their lives – like a computer game for children – and that help them take control.”