bluuebunny/crossref_metadata_2025_split huggingface dataset:
Video Games for Diabetes Self-Management: Examples and Design Strategies
Authors: Lieberman Debra A. 
Published: January 2014

The July 2012 issue of the Journal of Diabetes Science and Technology includes a special symposium called “Serious Games for Diabetes, Obesity, and Healthy Lifestyle.” As part of the symposium, this article focuses on health behavior change video games that are designed to improve and support players' diabetes self-management. Other symposium articles include one that recommends theory-based approaches to the design of health games and identifies areas in which additional research is needed, followed by five research articles presenting studies of the design and effectiveness of games and game technologies that require physical activity in order to play. This article briefly describes 14 diabetes self-management video games, and, when available, cites research findings on their effectiveness. The games were found by searching the Health Games Research online searchable database, three bibliographic databases (ACM Digital Library, PubMed, and Social Sciences Databases of CSA Illumina), and the Google search engine, using the search terms “diabetes” and “game.” Games were selected if they addressed diabetes self-management skills.
Two-Player Partnered Exergame for Obesity Prevention: Using Discrepancy in Players' Abilities as a Strategy to Motivate Physical Activity
Authors: Feltz Deborah L. , Irwin Brandon , Kerr Norbert 
Published: January 2014

Background: Physical inactivity is associated with obesity and type 2 diabetes. A key obstacle to physical activity is lack of motivation. Although some interactive exercise games (i.e., exergames—video games that require physical exertion in order to play) motivate players to exercise more, few games take advantage of group dynamics to motivate players' duration of exercise. In a test of the Kohler motivation gain effect, this study varied the ability level of a virtually presented partner in an interactive exergame that focused on abdominal strength to identify effects on a subject's (S') persistence with the task. Method: Male ( n = 63) and female ( n = 72) undergraduate students were randomly assigned to one of four conditions (individual control or low-, moderate-, or high- partner discrepancy) in a conditions x gender factorial design and tested on a series of isometric abdominal exercises using PlayStation 2 EyeToy: Kinetic software. They performed the first series of five exercises alone (trial block 1), and after a rest period, those in the partner conditions performed remaining trials (trial block 2) with a same-sex virtually presented partner whom they could observe during their performance, while those in the individual control condition performed the remaining trials alone. In the partner conditions, the partner's performance was manipulated to be always better than the S's, the exact difference depending on the discrepancy condition. The partnered tasks were conjunctive; that is, success in the game depended on the performance of the weaker team member. Persistence, the outcome measure for this study, consisted of the total number of seconds the S held the exercise position. Results: Using planned orthogonal contrasts on difference scores between blocks 1 and 2, results showed that persistence was significantly ( p < .001) greater in all experimental conditions with a virtually presented partner ( M = 33.59 s) than in the individual control condition ( M = −49.04 s). Subjects demonstrated more persistence in the moderate-discrepancy condition ( M = 51.36 s) than in the low-discrepancy condition ( M = 22.52 s) or the high-discrepancy condition ( M = 26.89 s). A significant quadratic trend confirmed the expected inverted-U function relating partner discrepancy and persistence ( p = .025). Although Ss persisted longer and had higher heart rate in partnered conditions, they did not perceive their exertion to be any higher than those in the individual condition. Conclusions: Virtually presented partners who are moderately more capable than participants are the most effective at improving persistence in exergame tasks.
Using an Alternate Reality Game to Increase Physical Activity and Decrease Obesity Risk of College Students
Authors: Johnston Jeanne D. , Massey Anne P. , Marker-Hoffman Rickie Lee 
Published: January 2014

Background: This quasi-experimental study investigated a game intervention—specifically, an alternate reality game (ARG)—as a means to influence college students' physical activity (PA). An ARG is an interactive narrative that takes place in the real world and uses multiple media to reveal a story. Method: Three sections of a college health course ( n = 115 freshman students) were assigned either to a game group that played the ARG or to a comparison group that learned how to use exercise equipment in weekly laboratory sessions. Pre- and post-intervention measures included weight, waist circumference, body mass index (BMI), percentage body fat (PBF), and self-reported moderate physical activity (MPA) and vigorous physical activity (VPA), and PA (steps/week). Results: A significant group x time interaction ( p = .001) was detected for PA, with a significant increase in PA for the game ( p < .001) versus a significant decrease ( p = .001) for the comparison group. Significant within-group increases for weight ( p = .001), BMI ( p = .001), and PBF ( p = .001) were detected. A significant group x time interaction ( p = .001) was detected when analyzing self-reported VPA, with both groups reporting decreases in VPA over time; however, the decrease was only significant for the comparison group ( p < .001). No significant group differences were found for MPA. Conclusions: It is important that any intervention meet the needs and interests of its target population. Here, the ARG was designed in light of the learning preferences of today's college students—collaborative and social, experiential and media-rich. Our results provide preliminary evidence that a game intervention can positively influence PA within the college student population.
Novel Approaches to Obesity Prevention: Effects of Game Enjoyment and Game Type on Energy Expenditure in Active Video Games
Authors: Lyons Elizabeth J. , Tate Deborah F. , Komoski Stephanie E. , Carr Philip M. , Ward Dianne S. 
Published: January 2014

Background: Some active video games have been found to promote physical activity adherence because of enjoyment. However, many active games are exercise themed, which may interfere with the distracting properties that make game-based exercise more enjoyable than traditional exercise. This study compared exercise-themed and game-themed active games to investigate differences in energy expenditure and enjoyment. Method: Young adults ( N = 100, 50 female, 55 overweight, aged 18–35 years) played two of four Wii Fit games (one aerobic game and one balance game per person) for 10 min each. Of the two aerobic games, one was exercise themed (jogging) and the other was game themed (hula hooping). Both balance games were game themed. Energy expenditure and enjoyment were measured. Results: After adjustment for gender and weight, aerobic games produced 2.70 kcal/kg−1/h−1 (95% confidence interval 2.41, 3.00) greater energy expenditure than balance games ( p < .001), but balance games were more enjoyable ( p < .001). In aerobic games, jogging produced greater energy expenditure than hula hooping in normal-weight and male participants ( p < .001); in overweight and female participants, no differences were found ( p > .17). Hula hooping was enjoyed more than jogging ( p = .008). Enjoyment predicted energy expenditure in aerobic games ( B = 0.767, p = .010). Conclusions: Aerobic games produced greater energy expenditure but lower enjoyment than balance games, and a game-themed aerobic game was found more enjoyable than an exercise-themed aerobic game. Integrating more strenuous activity into entertaining games instead of games that simply simulate exercise may be a fruitful avenue for active game development.
Increased Risk of Acute Hepatitis B among Adults with Diagnosed Diabetes Mellitus
Authors: Reilly Meredith L. , Schillie Sarah F. , Smith Emily , Poissant Tasha , Vonderwahl Candace W. , Gerard Kristin , Baumgartner Jennifer , Mercedes Lynne , Sweet Kristin , Muleta Daniel , Zaccaro Daniel J. , Klevens R. Monina , Murphy Trudy V. 
Published: January 2014

Introduction: The risk of acute hepatitis B among adults with diabetes mellitus is unknown. We investigated the association between diagnosed diabetes and acute hepatitis B. Methods: Confirmed acute hepatitis B cases were reported in 2009–2010 to eight Emerging Infections Program (EIP) sites; diagnosed diabetes status was determined. Behavioral Risk Factor Surveillance System respondents residing in EIP sites comprised the comparison group. Odds ratios (ORs) comparing acute hepatitis B among adults with diagnosed diabetes versus without diagnosed diabetes were determined by multivariate logistic regression, adjusting for age, sex, and race/ethnicity, and stratified by the presence or absence of risk behaviors for hepatitis B virus (HBV) infection. Results: During 2009–2010, EIP sites reported 865 eligible acute hepatitis B cases among persons aged ≥23 years; 95 (11.0%) had diagnosed diabetes. Comparison group diabetes prevalence was 9.1%. Among adults without hepatitis B risk behaviors and with reported diabetes status, the OR for acute hepatitis B comparing adults with and without diabetes was 1.9 (95% confidence interval [CI] = 1.4, 2.6); ORs for adults ages 23–59 and ≥60 years were 2.1 (95% CI = 1.6, 2.8) and 1.5 (95% = CI 0.9, 2.5), respectively. Conclusions: Diabetes was independently associated with an increased risk for acute hepatitis B among adults without HBV risk behaviors.
Effects of Simulated Altitude on Blood Glucose Meter Performance: Implications for In-Flight Blood Glucose Monitoring
Authors: Olateju Tolu , Begley Joseph , Flanagan Daniel , Kerr David 
Published: January 2014

Background: Most manufacturers of blood glucose monitoring equipment do not give advice regarding the use of their meters and strips onboard aircraft, and some airlines have blood glucose testing equipment in the aircraft cabin medical bag. Previous studies using older blood glucose meters (BGMs) have shown conflicting results on the performance of both glucose oxidase (GOX)- and glucose dehydrogenase (GDH)-based meters at high altitude. The aim of our study was to evaluate the performance of four new-generation BGMs at sea level and at a simulated altitude equivalent to that used in the cabin of commercial aircrafts. Methodology/Principal Findings: Blood glucose measurements obtained by two GDH and two GOX BGMs at sea level and simulated altitude of 8000 feet in a hypobaric chamber were compared with measurements obtained using a YSI 2300 blood glucose analyzer as a reference method. Spiked venous blood samples of three different glucose levels were used. The accuracy of each meter was determined by calculating percentage error of each meter compared with the YSI reference and was also assessed against standard International Organization for Standardization (ISO) criteria. Clinical accuracy was evaluated using the consensus error grid method. The percentage (standard deviation) error for GDH meters at sea level and altitude was 13.36% (8.83%; for meter 1) and 12.97% (8.03%; for meter 2) with p = .784, and for GOX meters was 5.88% (7.35%; for meter 3) and 7.38% (6.20%; for meter 4) with p = .187. There was variation in the number of time individual meters met the standard ISO criteria ranging from 72–100%. Results from all four meters at both sea level and simulated altitude fell within zones A and B of the consensus error grid, using YSI as the reference. Conclusions: Overall, at simulated altitude, no differences were observed between the performance of GDH and GOX meters. Overestimation of blood glucose concentration was seen among individual meters evaluated, but none of the results obtained would have resulted in dangerous failure to detect and treat blood glucose errors or in giving treatment that was actually contradictory to that required.
Determinants of the Accuracy of Continuous Glucose Monitoring in Non-Critically Ill Patients with Heart Failure or Severe Hyperglycemia
Authors: Dungan Kathleen M. , Han Wen , Miele Anthony , Zeidan Trisha , Weiland Karen 
Published: January 2014

Background: The accuracy of continuous glucose monitoring (CGM) in non-critically ill hospitalized patients with heart failure or severe hyperglycemia (SH) is unknown. Methods: Hospitalized patients with congestive heart failure (CHF) exacerbation (receiving IV or subcutaneous insulin) or SH requiring insulin infusion were compared to outpatients referred for retrospective CGM. Results: Forty-three patients with CHF, 15 patients with SH, and 88 outpatients yielded 470, 164, and 2150 meter–sensor pairs, respectively. Admission glucose differed (188 versus 509 mg/dl in CHF and SH, p < .001) but not the first sensor glucose ( p = .35). In continuous glucose error grid analysis, 67–78% of pairs during hypoglycemia were in zones A+B ( p = .63), compared with 98–100% in euglycemia ( p < .001) and 98%, 92%, and 99% ( p = .001) during hyperglycemia for the CHF, SH, and outpatient groups, respectively. Mean absolute relative difference (MARD) was lower in the CHF versus the SH group in glucose strata above 100 mg/dl, but there was no difference between the CHF and outpatient groups. Linear regression models showed that CHF versus outpatient, SH versus CHF, and coefficient of variation were significant predictors of higher MARD. Among subjects with CHF, MARD was not associated with brain natriuretic peptide or change in plasma volume, but it was significantly higher in subjects randomized to IV insulin ( p = .04). Conclusions: The results suggest that SH and glycemic variability are more important determinants of CGM accuracy than known CHF status alone in hospitalized patients.
Importance of Blood Glucose Meter and Carbohydrate Estimation Accuracy
Authors: Virdi Naunihal S. , Mahoney John J. 
Published: January 2014

Background: The clinical significance of blood glucose meter (BGM) error in the presence of increasing carbohydrate errors in diabetes patients who use both the BGM result and the carbohydrate estimation to dose insulin is unknown. Methods: This Monte Carlo simulation modeled diabetes patients who calculate insulin dosages based on BGM results and carbohydrate estimations. It evaluated the likelihood of on-target insulin dosing and clinically significant insulin dose errors based on data from five BGMs with different levels of performance (expressed as bias and imprecision [coefficient of variation (%CV)]) and increasing levels of carbohydrate estimation errors. The study was performed across three separate preprandial glucose (PPG) ranges (90–150, 150–270, and 270–450 mg/dl). Results: When carbohydrate estimation is accurate (%CV = 0%), the likelihood for on-target insulin doses ranged 50.1–98.5%. The likelihood depended on BGM performance and PPG range. In the presence of carbohydrate estimation errors (%CV = 5–20%), the likelihood of on-target insulin dosages markedly decreased (range, 27.2–80.1%) for all BGMs, the likelihood of insulin underdosing (range, 0–12.8%) and overdosing (range, 0–32.3%) increased, and the influence of BGM error on insulin dosing accuracy was blunted. Even in the presence of carbohydrate error, the BGM with the best performance (bias 1.35% and %CV = 4.84) had the highest probability for on-target insulin dosages. Conclusions: Both BGM and carbohydrate estimation error contribute to insulin dosing inaccuracies. The BGM with the best performance was associated with the most on-target insulin dosages.
Pediatric Use of Insulin Pump Technology: A Retrospective Study of Adverse Events in Children Ages 1–12 Years
Authors: Cope Judith U. , Samuels-Reid Joy H. , Morrison Audrey E. 
Published: January 2014

Background: Growing technological improvements in insulin pump design have increased the use of these devices in young children. To better understand the types of infusion pump-related problems and associated adverse events in this age group, we performed a comprehensive evaluation of pump-related adverse event reports received by the U.S. Food and Drug Administration (FDA) for children ages 1–12 years. Methods: A query was conducted of FDA's Manufacturer and User Facility Device Experience database from January 1, 1996, through December 31, 2009, in children ages 1–12 years involving insulin pumps. Report narratives were individually reviewed for age, gender, and seriousness of outcomes. Device or patient problems and potential contributory factors were assessed. Results: Over the past 14 years, 1774 (7%) of all insulin pump adverse event reports were identified in children ages 1–12. Of these reports, 777 (43%) resulted in hospitalization. In hospitalized cases ( n = 614), diabetic ketoacidosis and/or hyperglycemia were the predominant patient problems, and in other cases ( n = 98), hypoglycemia was evident. There were 106 emergency room visits, 19 cases requiring paramedic attention, and five deaths. The majority of reports indicated that the devices were not returned to the manufacturer, and root causes were not always confirmed. Conclusions: Younger children with diabetes deserve careful consideration of the risk and benefit of insulin pump technology. Studies are needed to better understand pediatric safety issues and to identify the root cause of adverse events. Problems related to patient education, device misuse, and malfunctions were found, highlighting the need to strengthen user training for children and their caregivers.
Comparative Analysis of the Efficacy of Continuous Glucose Monitoring and Self-Monitoring of Blood Glucose in Type 1 Diabetes Mellitus
Authors: Floyd Baraka , Chandra Prakash , Hall Stephanie , Phillips Christopher , Alema-Mensah Ernest , Strayhorn Gregory , Ofili Elizabeth O. , Umpierrez Guillermo E. 
Published: January 2014

Background: Self-monitoring of blood glucose (SMBG) and continuous glucose monitoring (CGM) have been proven effective in improving hemoglobin A1c (HbA1c) and in reducing hypoglycemia in patients with type 1 diabetes mellitus (T1DM). It is not clear, however, if CGM provides further efficacy and safety benefits beyond SMBG in the management of T1DM. Methods: MEDLINE (1966-November 2009), COCHRANE REGISTRY (all years), and EMBASE (1980-November 2009), and article bibliographies were searched for randomized controlled trials (RCTs) investigating the use of CGM in patients with T1DM, with clinical outcomes, including HbA1c and hypoglycemia and/or hyperglycemia. Results: Fourteen RCTs met eligibility criteria [ n = 1188 patients, 97.4% with T1DM, age 29.0 ± 14.3 years, diabetes duration 11.7 ± 7.0 years, and baseline HbA1c 8.3 ± 0.8% (mean ± standard deviation)]. Compared with SMBG, the use of CGM was associated with a greater reduction in HbA1c [−0.3% (confidence interval: 0.4, −0.2), p < .0001]. The number of hypoglycemic events was not significantly different between the CGM and SMBG groups (0.52 ± 0.52 versus 0.52 ± 0.63 events/day, p = .5), but duration of hypoglycemia was shorter for the CGM group (75 ± 39 versus 89 ± 19 min/day), with an incremental reduction of hypoglycemia duration of −15.2 min/day, p < .0001. Continuous glucose monitoring also resulted in a shorter duration of hyperglycemia than SMBG (172 ± 125 versus 217 ± 152 min/day, p = .04). Conclusions: The use of CGM is associated with improvement in metabolic control in T1DM, with significant short- and long-term reductions in HbA1c and reduction in the duration of periods of hypoglycemia and hyperglycemia versus SMBG.
Overview of Fluorescence Glucose Sensing: A Technology with a Bright Future
Authors: Klonoff David C. 
Published: January 2014

Fluorescence represents a promising alternative technology to electrochemistry and spectroscopy for accurate analysis of glucose in diabetes; however, no implanted fluorescence glucose assay is currently commercially available. The method depends on the principle of fluorescence, which is the emission of light by a substance after absorbing light. A fluorophore is a molecule that will absorb energy of a specific wavelength and reemit energy at a different wavelength. A fluorescence glucose-sensing molecule can be constructed to increase or decrease in fluorescence from baseline according to the ambient concentration of glucose. A quantum dot is a semiconductor crystal that can serve as a sensor by fluorescing at a desired wavelength or color, depending on the crystal size and materials used. If receptor molecules for glucose can be adsorbed to single-wall carbon nanotubules, then the resulting binding of glucose to these receptors will alter the nanotubes' fluorescence. Fluorescence glucose sensors can provide a continuous glucose reading by being embedded into removable wire-shaped subcutaneous or intravenous catheters as well as other types of implanted structures, such as capsules, microcapsules, microbeads, nano-optodes, or capillary tubes. Fluorescence glucose-sensing methods, which are under development, offer four potential advantages over commercially used continuous glucose monitoring technologies: (1) greater sensitivity to low concentrations of glucose, (2) the possibility of constructing sensors that operate most accurately in the hypoglycemic range by using binding proteins with disassociation constants in this range, (3) less need to recalibrate in response to local tissue reactions around the sensor, and (4) no need to implant either a transmitter or a power source for wireless communication of glucose data. Fluorescence glucose sensors also have four significant disadvantages compared with commercially used continuous glucose monitoring technologies: (1) a damaging foreign body response; (2) a sensitivity to local pH and/or oxygen, which can affect the dye response; (3) potential toxicity of implanted dyes, especially if the implanted fluorophore cannot be fully removed; and (4) the necessity of always carrying a dedicated light source to interrogate the implanted sensor. Fluorescence sensing is a promising method for measuring glucose continuously, especially in the hypoglycemic range. If currently vexing technical and engineering and biocompatibility problems can be overcome, then this approach could lead to a new family of continuous glucose monitors.