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InsuOnline: An electronic game for teaching insulin therapy

M3 India Newsdesk Feb 19, 2018

InsuOnline is the first ever serious electronic game developed for medical education on insulin therapy in diabetes.


The game was designed by a team consisting of clinical endocrinologists, game designers, and experts in medical education, with the help of other professionals- programmers, graphic designers, and sound editors. The tool is aimed at educating primary care physicians (PCPs) on how to best use insulin in the treatment of diabetes mellitus (DM) in the primary health care setting.

InsuOnline, the 3D app can be downloaded on laptops or notebooks having Windows or Mac OS. The platform is user-friendly and can be easily controlled with a mouse. The game aims to teach the following:

  • Recognise the goals of glycemic control in adults with DM
  • Identify the time when to initiate insulin in type 2 DM
  • Obtain know-how to start insulin in type 2 DM (“bedtime” scheme)
  • Orientate proper insulin use (storing, injection technique, and devices)
  • Prevent, recognise, and treat hypoglycemia
  • Orientate and to interpret self-monitoring of blood glucose
  • When and how to adjust insulin dosage
  • Compare types of insulin (NPH, regular) and know when to use which
  • When to intensify insulin therapy in type 2 DM
  • How to intensify insulin therapy in type 2 DM (“basal-plus” scheme)
  • Prescribe intensive insulin therapy (“basal-bolus” scheme)
  • Recognize type 1 DM and how to start treatment
  • Identify diabetic ketoacidosis and to start treatment
  • Recognize the main barriers to insulin initiation and know how to address them
  • Orientate lifestyle changes and manage oral antidiabetic drugs in association with insulin
  • Recognize the main factors that require insulin dosage adjustment and how to manage them

Almost 422 million adults worldwide suffer from Diabetes mellitus (DM), making it one of the most prominent health issues of the 21st century. In most countries, diabetics are treated by PCPs and not Endocrinologists or Diabetologists. Only 24 to 56% of the patients with DM have shown any improvement in glycemic control despite treatment.

The problem?

The root cause seems to be a low frequency of good glycemic control in DM patients, which can be attributed to various factors. One of the most likely factors could be the lack of knowledge and skills on part of the PCPs with regards to disease management, especially the use of insulin.

Decreased competence of PCPs leads to underuse of insulin and ultimately poor glycemic control. Studies in the past have proven that there is a difference of almost 3 to 5 years between the first signs indicating that the patient requires insulin therapy and the actual initiation of insulin therapy.

Drawbacks of conventional methods

The most commonly advocated form of delivering medical education to the PCPs is via CMEs on DM and insulin. This method, however, has its own limitations. CME activities usually include lectures and group discussions. These methods may not bring about active participation of the participants since they are usually small sessions and they do not have long-lasting effects.

Electronic games as a means of education

Electronic games are known to have a tremendous influence on its users. The choice of electronic games as a teaching strategy is advocated because of its potential educational effectiveness, ease of access, flexibility, and easy availability. Moreover, most college students are familiar with the medium and favour this medium for learning. Allowing medical students and practitioners to practice their skills in an electronic medium would lead to increased efficacy of treatment for patients.

In InsuOnline, participants take up the role of a doctor in a PHC setting. Their aim is to improve glycemic control in a series of 19 patients with increasing complexities of the condition. These patients are to be managed by either initiating or adjusting the dose of insulin. The situations and the patients are intended to simulate a real life PHC setting. This game gives immediate feedback to the participants and they can only progress through the game when they are able to make optimal decisions for their patients.

Trials Related to InsuOnline

Diehl LA et al. (2017) conducted a study to determine the applicability, user acceptance, and educational effectiveness of InsuOnline when compared to traditional CME activity. They found that InsuOnline was more effective for educating PCPs about insulin administration when compared to traditional CMEs. The effectiveness of this game was even more effective than online learning sessions. It was found to be highly applicable, as 80% participants in the trial were able to complete the game with minimal or no assistance.

The pilot study to assess the usability and playability of InsuOnline was also done by Diehl LA et al. where they found that the participants of the study (PHP’s) found InsuOnLine to be easy to play, fun, and useful for learning.

Advantages of InsuOnline

Using a well-designed game such as InsuOnline for medical education has many advantages:

  • Educational adequacy: InsuOnline has been designed based on several important pedagogical principles of adult learning and problem-based learning such as motivation, goal-orientation, relevancy-orientation, self-pacing, timely and appropriate feedback, contextualization, and practical (i.e. hands-on) approach with active participation of the learner.
  • Adding entertainment to the learning experience: Games make learning experiences more enjoyable, engaging and thus, more effective.
  • High emotional involvement of the learner: A person is more emotionally involved in learning through games than learning through traditional CMEs. Emotional involvement can bring about drastic changes in attitudes and behaviors of the learners.
  • Increased flexibility of learning: Games are more flexible than traditional CMEs as they can be accessed according to the learners’ own time, availability and learning pace.

Owing to its merits, InsuOnline can be used as a valid tool for large scale CMEs on Insulin therapy. This educational tool can be very useful in improving PCPs performance all over the world, which would ultimately lead to improved glycemic control, decreased number of complications and a better quality of life in the patients who require insulin therapy.

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