Computer Based Intervention for Type 2 Diabetes in Youth
Condition: Type 2 Diabetes
MeSH terms: Diabetes Mellitus; Diabetes Mellitus, Type 2
Study type: Interventional

Summary: 
      Interactive multimedia programs have been demonstrated to produce substantial change in
      children's dietary behaviors. This SBIR-Phase 2 protocol will evaluate the two video game
      interventions designed to change diabetes related behaviors, including diet and physical
      activity: Escape from Diab! and Nanoswarm that were developed in Phase 1. The primary
      hypotheses for this SBIR-Phase 2 protocol are:

        1. The two video games will result in greater dietary and physical activity change than a
           knowledge based control group.

        2. The effects of the video games will be mediated by changes in child preferences for FV
           and PA, self-efficacy to change FV intake and PA, and intrinsic motivation to eat FV and
           PA.

      We will test these hypotheses by evaluating the two video games in a randomized experiment.
      To minimize costs, we will evaluate the impact of the games on behavior (diet and PA), BMI
      and related psychosocial variables, but not blood values. Our long-term goal is reducing the
      incidence of Type 2 diabetes and related health problems in youth.
    

Detailed description: 
      Increasing numbers of minority youth are at risk for developing Type 2 Diabetes (T2D) because
      of family history and overweight. While precise incidence and prevalence rates for T2D among
      children are not available, the prevalence has increased substantially in the last ten years,
      likely due to parallel increases in obesity among children. These cases are expected to
      progress to end organ damage at an early age, with the resultant increased personal and
      societal costs. Probable risk factors for T2DM include ethnicity (African American, Hispanic,
      Native American), family history of diabetes, and obesity. Prevention is key to reducing
      risks for T2D. The only modifiable risk factor is weight, which reflects dietary and physical
      activity practices. A diet high in fruit and vegetables, and appropriate in total calories
      and low in dietary fat are likely protective against both obesity and T2D. Although national
      data suggest the percentage of kilocalories (kcal) from fat consumed by children aged 2-17
      decreased between 1989 and 1995 (now at 33% of total kcal), actual fat intakes did not
      decrease. Kcal intake, however, increased. Children's current intake of fruit and vegetables
      is less than one-half of the 5-A-Day goal. Changing the diet and physical activity practices
      to impact adiposity among children 10 to 12 years old before the onset of obesity or early in
      obesity holds great promise of preventing T2D. Furthermore, it is approximately this age that
      children assume more responsibility for their diet and physical activity, and thereby the
      intervention can be expected to have a greater impact on behavior. Children at the 50%tile or
      higher BMI are those most likely to progress to obesity, and thereby provide an important
      target group for obesity prevention.

      Video games focused on promoting T2D-related changes in diet and physical activity, based on
      the most current theories of health behavior, hold the promise of preventing T2D among
      children, and thereby reducing lifelong disease burden. Unlike traditional media-based
      interventions (print, graphic, audio/visual, television broadcast), computer technology
      provides opportunities to influence behavior change through direct, personalized interactive
      experiences.

      As part of a SBIR-Phase I, we created two video games: Escape from Diab! and Nanoswarm -
      Invasion from Inner Space. These intervention video games propose to increase fruit and
      vegetable intake to reduce total calories by displacing high fat, high calorie foods;
      increase water intake to decrease sweetened beverage consumption and total calories; increase
      physical activity; and decrease inactivity (e.g., TV watching, playing commercial video
      games). The behavioral and educational objectives address national behavior change
      objectives, including:

        -  Three to five servings of fruit (F) or 100% fruit juice (J) per day and Four to seven
           servings of vegetables (V) per day (based on child recommended calorie intake for age
           and weight),

        -  Five to eight glasses of water (W) per day,

        -  Moderate to vigorous Physical Activity (PA) of at least 60 min/day, and

        -  Physical Inactivity (PI) (TV, e-games, telephone) of no more than 2 hours per day.

      Both games use an adventure storyline to capture the children's interest and attention, and
      thereby enhance their desire to keep coming back to the game across multiple sessions
      (between which behavior change goals are attempted). The storylines provide messages that
      reinforce the diet and physical activity change objectives. Seamlessly woven into each
      adventure session are programmed procedures for promoting behavior change (goal setting, goal
      review), which were tailored to characteristics of the child obtained through self report.
      Behavior change knowledge games, seamlessly woven into the storyline, are used to provide the
      basis for effective goal setting; and energy balance games, also seamlessly woven into the
      storyline, are used to provide the knowledge necessary to effectively self control caloric
      intake and output.
    

Intervention name(s): Video Games; Web and DVD knowledge
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Two interactive, computer-based video games (9 sessions each) played in sequence to increase fruit,vegetable,water intake + physical activity + decrease TV viewing.; Web and DVD based knowledge games
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Type 2 Diabetes; Prevention; Children; Diet; Physical Activity