The Effect of Game-Based Interventions in Rehabilitation of Diabetics: A Systematic Review and Meta-Analysis

Telemed J E Health. 2016 Oct;22(10):789-797. doi: 10.1089/tmj.2015.0165. Epub 2016 Apr 4.


Introduction: Game-based interventions have been proposed as a way to improve both patient adherence to physical activity (PA) and disease-related knowledge to achieve better self-management of blood glucose levels (HbA1c). The objective of this study was to systematically review the literature on the effect of game-based interventions on HbA1c, diabetes-related knowledge, and physical outcomes in rehabilitation of diabetes patients.

Methods: We conducted a systematic literature search in MEDLINE, EMBASE, PEDro, Scopus, Cochrane Central Register of Controlled Trials, CINAHL, and Psych INFO in October 2014 based on a priori defined inclusion criteria: patients with diabetes (type 1 or type 2), game-based interventions, and randomized controlled trials.

Results: The database search identified 1,101 potential articles for screening, four of which were eligible for the present systematic review. Game-based interventions show no effect on HbA1c (three studies) standardized mean difference = -0.10, 95% confidence interval = [-0.33, 0.14] compared to usual care or waiting lists. Game-based interventions were superior to controls in improving health-related quality of life, muscle strength, and balance (one study). No difference was found between game-based interventions and usual care or waiting lists in terms of diabetes-related knowledge (one study).

Discussion: PA is important for diabetes management. The present review indicates that game-based interventions are not superior to ordinary PA in controlling HbA1c. Due to the weak methodological quality of the included studies and the very low body of evidence, the likelihood that the real effect of game-based interventions will be substantially different (i.e., large enough difference to possibly affect decision-making) is high.

Keywords: behavioral health; diabetes mellitus; distance learning; e-health; rehabilitation; telehealth; telemedicine.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Blood Glucose
  • Diabetes Mellitus / rehabilitation*
  • Exercise
  • Games, Recreational*
  • Glycated Hemoglobin A
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Muscle Strength
  • Quality of Life
  • Randomized Controlled Trials as Topic


  • Blood Glucose
  • Glycated Hemoglobin A