Numeracy in Adolescents With Type 1 Diabetes: Assessment and Application of a Video Game Intervention

Ereny Bassilious; Devin Johnson; Elif Bilgic; Adam Dubrowski; Alan Schwartz; Kahono Hirasawa; Farid Mahmud

doi:10.7759/cureus.108251

Numeracy in Adolescents With Type 1 Diabetes: Assessment and Application of a Video Game Intervention

Cureus. 2026 May 4;18(5):e108251. doi: 10.7759/cureus.108251. eCollection 2026 May.

Authors

Ereny Bassilious¹, Devin Johnson², Elif Bilgic³, Adam Dubrowski⁴, Alan Schwartz⁵, Kahono Hirasawa⁶, Farid Mahmud⁷

Affiliations

¹ Pediatric Endocrinology, McMaster University, Hamilton, CAN.
² McMaster Health Education Research, Innovation & Theory (MERIT) Centre, McMaster University, Hamilton, CAN.
³ Pediatrics, McMaster University, Hamilton, CAN.
⁴ maxSIMhealth Group, Ontario Tech University, Oshawa, CAN.
⁵ Medical Education, University of Illinois at Chicago, Chicago, USA.
⁶ Health Sciences, McMaster University, Hamilton, CAN.
⁷ Pediatric Endocrinology, University of Toronto, Toronto, CAN.

Abstract

Background: Numeracy is about understanding and using numbers daily, and low numeracy leads to poor clinical outcomes in adults with diabetes. However, the pediatric literature on this topic is limited.

Objectives: Hence, through this pilot project, we are exploring the role of a novel video game intervention to enhance diabetes-related numeracy and related measures.

Research design and methods: From May 2011 to July 2011, using data from focus groups with diabetes team members and adolescents, we created a video game addressing diabetes numeracy. Diabetes numeracy was assessed using the Adolescent Diabetes Numeracy Test (aDNT14). Correlation of aDNT14 was calculated with cumulative A1C, quality-of-life (QL-PedsQL 3.0 inventory), and demographic data. General numeracy, assessed using the Wide Range Achievement Test, Fourth Edition (WRAT-4), and health literacy, assessed using the Rapid Estimate of Adolescent Literacy in Medicine-Teen (REALM-Teen), were also assessed. Participants were 13-18 years old with type 1 diabetes who had high proficiency in the English language and had no known learning disability, psychiatric/behavioral diagnosis, or visual or hearing impairment. Participants played the video game in three sessions, and their diabetes numeracy was re-evaluated. For retention of gains from the video game, baseline measures were re-evaluated within one month following the last session and cumulative A1C over six months. Analysis included descriptive and inferential statistics.

Results: Forty-two adolescents participated. Baseline A1C and numeracy scores were significantly associated. Diabetes numeracy was also significantly related to scores of general numeracy and literacy. However, the video game intervention had no long-term impact on A1C, diabetes-related numeracy, or QL measures. Conclusion: Although our diabetes-focused video game intervention dedicated to literacy and numeracy had no long-term impact on glycemic control, diabetes-focused numeracy, or QL measures, our findings support the feasibility and potential value of an experiential, game-based approach for improving type 1 diabetes. Hence, there is a need for larger studies with flexible and longer exposure and/or integration into routine education to explore sustained clinical and patient-reported impacts.

Keywords: numeracy; paediatric endocrinology; simulation in medical education; type 1 diabetes; video game intervention.