New Gamification App Creates Diabetes Ninjas

We’ve seen some dull diabetes programs through time, to be certain. They make an effort, but most do not figure out how to keep us patients engaged, therefore we just stop fussing with them. Perhaps the pop culture phraseology should be substituted to state, “There’s a program for this… but really you will not need to use it for long!”

Fortunately, a pediatric endo in Ohio is working on something that may change how we see mobile programs for diabetes. Dr. Jennifer Dyer, called @EndoGoddess on Twitter, is creating a gamification strategy that she’s been speaking about publicly since introducing at the Patient Engagement Symposium prior to the big Health IT conference #HIMSS16 held in Las Vegas earlier this season.

A Diabetes Ninja App   

The new app is not about logging or tracking diabetes info, Dyer says, but instead establishing the customs for effective long-term D-management. The program is still in development and in early testing. In fact, it doesn’t even have an official name yet, but has been referred to as the COPEDS Black-Belt program (called after the Central Ohio Pediatric Endocrinology and Diabetes Services in which Dyer works). Its ‘ninja’ strategy will certainly appeal to people that are young!

It walks in the footsteps of the original Super Mario games, where gamers tackle various villians and challenges, and advance levels as they strive to accomplish the supreme end-goal — in this case getting a “black belt loaf of diabetes” as opposed to rescuing the Princess.

The open-source games contained are being selected by the teenagers currently testing the program, Dyer says. “Some are tough, some are easy, and there’s a combination of girls’ and guys’ games. There’s also a small ‘ninja’ shop where you could use points to buy things to dress up your own ninja, or purchase weapons and accessories.”  

Diabetes Ninja app

This will be set up as a little arcade having an ’80s retro feel, where a leader board shows greatest scores for the various free open-source games. While the games are not all especially ninja-themed, users gain points that go toward their black belt status.

The only way to advance to buckle levels would be to meet a two-week objective of checking your blood sugars four times every day, or bolus insulin with meals three or more times every day. Every time you meet this goal for two weeks, you advance a different buckle level till you finally earn your way up to black belt over the duration of 90 days.

If you start slipping one of these customs, you can build your standing back up with extra efforts. But exactly like any game, if you continually miss a target, then you are going to encounter a “Game Over” message and need to start from scratch.

Doctors in the Game

And that goes beyond just entertaining inspiration for kids. Dyer has really set up an administrative area in which healthcare providers can track their gamer-patient’s progress by means of a Diasend-based clinical information platform.

“Eventually we would like to get it set up through an open-source data platform such as Tidepool, that will automatically bring all of this information together,” Dyer says, speaking to combining sufferers’ pump and CGM information, etc. with information from her program.

To create this of additional clinical relevance, daily surveys will be built to the program. Most of these will just be fun questions intended to engage the teens, for example: Would you like Batman or Superman? Who’s your fav instructor? Do you think Donald Trump has hair?   But two ‘willingness for change’ questions will also be sprinkled in there: Do you feel prepared to make changes to produce a better bolus habit? Would you feel confident to improve your bolus customs?

“They take this questionnaire daily, therefore we can measure how empowered they’re feeling combined with how they’re performing on the diabetes management customs,” Dyer says.

Building on Past Failures

Dr. Jennifer DyerThis ninja program comes from the development of her job in individual involvement, and trying to modify behaviors inside her kids and teens with diabetes, she says.

What she’s shooting for is “true gamification” that involves customers and motivates them to take action, instead of just a simple system of ‘point-ification’ or ‘badge-ification’ that many healthcare game programs are based on.

“This really came out of growth of my previous failures. They worked at first, but then they stopped working in maintaining individuals with diabetes motivated to bolus or check blood sugars.”

Years before, she started texting her pediatric patients reminders to check BGs and bolus insulin for foods. That practice worked, showing A1Cs dropped from 10% to some 7 or 8%. Additionally, it put Dyer on the #mHealth map using a TEDTalk along with other vulnerability. But after three weeks, she kept texting the same patients and learned they were losing interest. Their A1Cs rose back up, and she says high school patients were not interested in these texting reminders.

“I understood that three weeks is about as much time as (most young people) are prepared to use a technology. At first they’re really into it, then they are not into it.”

Mainly, “life was too active” was a common response Dyer heard, along with “I am just tired of diabetes and also want more inspiration.”

That led her into making the original EndoGoddess program to get iTunes in 2011, a cell journal rewarding BG checks and insulin dosing using iTunes download factors for music.

“Then I learned not everyone cared about iTunes or audio downloads, like I thought they would,” she says with a laugh.

Next up, Dyer’s EndoGoal program took the audio rewards and instead offered a prepaid Visa card as an incentive. Still, she discovered even that wasn’t working long-term.

Why, she asked her patients?

“Turned out it is because diabetes is tough, and finally everybody who is doing it well and thriving has an automatic habit of doing these things. It is kind of like brushing your teeth or other extra-curricular tasks, you just do them.”

All of that led her and her and colleagues in Ohio to examine habit development in healthcare, and how using gamification could inspire patients who want it.

Helping patients develop needed positive D-habits became the clear goal of this upcoming mobile program venture, Dyer says.

Ninja’ing Your Diabetes Habits

That’s the center of it; it is a tool for anyone who needs help creating good habits of assessing their blood sugar frequently or bolusing insulin with meals. It is built on the grounds that doing something for 90 days in a row is really a secret to establishing a habit.

“It doesn’t take as much property in the mind when it is an automatic dependence,” Dyer says. “That’s exactly what I want for my teens — I want them thinking about being a teen, not thinking about diabetes as much.”

Blackbelt Ninja ProfileThe early version of this app did not include a way to connect with other users for peer assistance, and Dyer says she discovered the teens were excited for just about a week before they started losing interest.

She realized that a peer relationship element was needed, giving the teens a opportunity to help inspire each other as they made their way through the games. And it naturally it needed to be in their phones, the main portal to the majority of teenagers’ lives these days.

“We took the step to produce this game community-based, so that they could continue to come back into the arcade and play with their pals.”

Among the teens has already earned    black belt status, Dyer says, and each time she sees him she describes him as a ninja.

“He is completely ninja’d his diabetes, and made these changes that are helping him daily be great in diabetes management.”  

Dyer says she had intended to have this ninja program completed and accessible by January 2016, but the open-source database that they had been using to create the code was bought by Facebook — meaning they’d eliminate access to 1.5 years of code by year’s end. So, that meant turning into Amazon and shifting there.

When the program’s nearer to completion in the coming months, Dyer says she intends to perform a larger beta evaluation with her own patients in the Fall.

“I am showing it works and applying for some grants, then once we establish it works, we could start the process of commercializing it in about a year,” she says.

Mobile Health Helps

In lots of ways, Dyers work reminds us of exactly what Dr. Joyce Lee is performing at the University of Michigan (a direct rival of Ohio State University in which Dyer attended!) , presented at last Fall’s #MakeHealth festival. Diabetes Emoticons appDr. Lee is working with game designers to create a program as similar lines that involves kids with diabetes taking care of a pet and getting things the better they perform in diabetes management.

And while it is not a game, a new Diabetes Emoticons program offers an enjoyable way for individuals — especially kids and teenagers — to express their thoughts about diabetes through their telephones. We wrote in this past year, however it has just become available on the Apple shop; not yet prepared for Android, however.

Meanwhile, there are an array of new wellness programs being developed daily.

One that caught our eye is a new grocery store program called ValueMe, that comes out of MIT where two pupils believed the idea to provide meals shoppers “supplements” that would speed food purchased in the supermarket as to how whether they’re lacking important nutrients. It is an interesting idea that might help teach people about the food choices they’re making.

OK, the program doesn’t actually provide this info until after you have already bought the meals, but if people are motivated to take a few minutes post-shopping they might really learn something in their particular food choices — good or bad.

For Dyer’s part, she says she’s inspired by efforts such as the FitBit Challenge that Target is a part of, in which FitBit users who walk accrue things and finally are able to help feed families in developing countries. That’s an amazing way to use health.

“I would like it to become that finally, endos and educators do not need to do anything manually for their patients to use (programs like mine), except to signal up them and look at the information — and to be excited that this is working as a instrument. As an endo, you actually want a tool to help your patients meet their goals, instead of beating them on.”

Right. That is the Holy Grail of wellness programs? To be achieve better outcomes.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a customer health blog focused on the diabetes community. The content is not medically reviewed and doesn’t stick to Healthline’s editorial instructions. To learn more about Healthline’s partnership with Diabetes Mine, please click here.

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