Numeracy in Adolescents with Type 1 Diabetes: Assessment and Gaming Intervention – A Pilot Project

Context: Numeracy is the ability to understand and use numbers in daily life and is central to diabetes self-management. In this pilot project we examined the relationship between diabetes numeracy (DN), A1C (a measure of blood sugar control), and quality of life (QL) in an ethnically diverse population of adolescents with type 1 diabetes (T1D) and then applied a novel video game intervention geared at improving diabetes numeracy. Research Design and Methods: Through collaboration with diabetes team members and adolescents at our institution, as well as experts in technology development and education research, we created a video game de novo addressing DN. We assessed DN using the adolescent diabetes numeracy test (aDNT14) and correlated this with cumulative A1C, QL, and demographic data in 42 adolescents. After playing the video game on 3 separate occasions we re-evaluated participants’ diabetes numeracy (n=33). To test retention of the video game effects we re-evaluated baseline measures within 1 month following the last video game session and cumulative A1C over the following 6 months. Results: There is a significant association between baseline A1C and numeracy scores (r=-0.43, p= 0.004) independent of ethnicity. Although improvement in numeracy skills after the video game intervention did not reach statistical significance, some domains of QL measures significantly improved. In secondary exploratory analysis, reading literacy was highly associated with diabetes numeracy skills (p<0.001). In addition, stronger numeracy skills were associated with more intense insulin regimen (insulin pump) (p=0.0272). Finally, baseline diabetes related quality of life was inversely associated with the number of times per week the patient reported to have forgotten to take insulin (p = 0.0009). Conclusion: Numeracy skills are strongly correlated with diabetes control and is a skill set that is not dependent on ethnicity or socio-economic status. Some limitations to the study, in particular the controlled administration of the video game, may have limited the intervention effect of the video game on the primary outcome measures. However, video games are an interactive and developmentally appropriate method of delivering experiential learning to adolescents and should be explored further as a means of delivering diabetes education to adolescents with T1D.