INSULOT: A cellular phone-based edutainment learning tool for children with type 1 diabetes

A particular type of education needs to be designed to encourage, motivate, and boost the confidence of type 1 diabetic patients. “Edutainment” has been recognized as an attractive approach to improving educational outcomes for such patients (1). As an edutainment tool, we have developed a cellular phone-based “game” that we call “INSULOT,” a term coined to denote “insulin” and “slot machine.” This tool has been implemented and preliminarily evaluated.

INSULOT is a special, three-window slot machine designed to teach the relationships among plasma glucose level, food (carbohydrate grams), and insulin dosage. INSULOT uses algorithms to simulate postprandial glucose levels, while considering distributions to incorporate clinical uncertainties. The first step is to calculate the “carbohydrate grams” in each food using the concept of total available glucose (2). Then, the insulin-to-carbohydrate ratio is used to simulate the amount of carbohydrates absorbed by a one-unit dose of insulin (3). The final carbohydrate gram level is then calculated by subtracting carbohydrates absorbed by insulin from the intake of carbohydrate grams. Finally, INSULOT demonstrates various images based on the appropriateness of the postprandial plasma glucose level, and the combination of these is used to determine the final score for each time the game is played. INSULOT is a Java 2 Micro Edition application, designed for third-generation cellular phone systems. The application can run as a stand alone and also be integrated into a World Wide Web environment. All personal settings for algorithms (e.g., body weight, age) used are stored in a web database system and can be updated from the cellular phone.

The game was evaluated by 30 diabetic patients (12–24 years of age) on the basis of entertainment, usability, and its clinical usefulness at a summer camp in Kochi Prefecture, Japan, in 2003. We used a structured survey of 13 questions with a response scale ranking from 1 to 7 (1 = strongly disagree and 7 = strongly agree). Generally, the patients felt the game was interesting (mean ± SE 5.57 ± 0.22). Approximately 80% of patients thought that INSULOT could be recommended to other type 1 diabetic patients. INSULOT’s overall usability was highly scored, and most patients were able to play the game without any instruction. More than 80% of patients agreed that the game was useful as a learning tool (5.44 ± 0.29).

Advantages of cellular phone-based games are their interactivity and portability, which could enhance health care delivery and education. Although there are some concerns about the harmful effects of games on adolescents, it is our role as health professionals to develop ways to make the most of such applications, with the goal being health-outcome improvements. One of the most important, but difficult, issues for any edutainment system is how to establish a balance between education and entertainment. A game does not appeal to users if education is overemphasized; however, it cannot be called a learning tool if the game has little appropriate learning content.

In conclusion, we have successfully developed an edutainment tool that combines fun and learning for young people with type 1 diabetes. Our preliminary evaluation demonstrated that the edutainment provided by our INSULOT game was well received as an efficient and enjoyable learning tool. (More information is available at https://weds.shis.uth.tmc.edu/INSULOT.)