14. The Effects of a Computer-Based Driving Game on Hypoglycemia Education Among Adolescents with Type-1 Diabetes

Abstract

Purpose: Individuals with type 1 Diabetes Mellitus (Tl OM) are at high risk for hypoglycemia (HG); HG while driving may result in serious accidents. Failure to perform self-blood glucose monitoring (SBGM) before driving and inadequate knowledge about preventive recommendations increases the risk of HG while driving, and is a particular concern for adolescents. The current study piloted an innovative computerbased driving game to increase awareness of risks and inform adolescents of current safety recommendations. Methods: Ninety-nine participants (14-16 years) with TlDM were recruited from adolescent diabetes clinics to participate in a game-based education program about HG. which included driving modules designed to simulate the effects of hypoglycemia on vehicle operator motor skills. Participants completed a short baseline (Tl) preand post-task questionnaire about HG which queried them on the areas of driving behaviors, HG history, driving history. SBGM habits, and self-efficacy regarding hypoglycemia awareness. A short follow-up questionnaire (T2) queried hypoglycemia knowledge and intention to engage in behaviors to reduce the chance of hypoglycemic episodes while driving. Paired sample t tests were used to assess changes in HG knowledge variables. Results: Almost all adolescents reported morning HG as the most frequent time of HG 62% (61/99) before breakfast and 31 % (31 /99) after breakfast, but before lunch. Only 59%(31/99) performed SBGM four or more times daily as recommended; 22% (22/99) tested twice daily or less. Almost a quarter (23%, 20/86) had an episode of severe HG in the past 3 months. Over half (53%, n = 52) of adolescents reported driving every day, 26%(n = 26)did notdrive,21% (n = 21) drove up to three times a week or less. Of those who drive, 41 % ( 30/73) either agreed or strongly agreed that they drive when their blood glucose is <90 mg/dL recommended as safe and 59% (43/73) reported experienced mild HG at while driving at least once. Twenty-six percent (26/99) thought that HG was not serious at all. Following completion of the driving-game module. the percentage of the sample that correctly answered each of the HG knowledge variables was significantly higher than at baseline: lowest safe driving blood gt ucose level (34% Tl, 81 % T2; p < .001 ). intention to test glucose before driving (69% Tl , 92% T2; p .001 ), what to do if blood glucose feels low before driving (79% Tl, 92% T2; p < .01). and what to do if blood glucose feels low while driving (79% Tl, 90% T2; p < .01 ). Conclusions: A computer driving-game intervention designed to simulate the effects of HG on motor skills was very effective in increasing both short-term know ledge about HG and intentions to increase HG prevention behaviors. Given the limited time for clinicians to interact with adolescent patients, gamebased education modules may be an efficient way to teach adolescents with Tl OM, important skills to prevent HG while driving, as well as reduce the risk of driving-related negative health outcomes.