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Pediatr Diabetes. 2019 Dec 29. doi: 10.1111/pedi.12974. [Epub ahead of print]

Glycemic control in adolescents with type 1 diabetes: Are computerized simulations effective learning tools?

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Nursing Department, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Department of Learning, Instruction and Teaching, University of Haifa, Haifa, Israel.
Pediatric Diabetes Clinic, Institute of Diabetes, Endocrinology and Metabolism, Rambam Health Care Campus, Haifa, Israel.
Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
The Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel.



Type 1 diabetes mellitus (T1DM) in adolescent patients is often characterized by poor glycemic control. This study aimed at exploring the contribution of learning with computerized simulations to support: (a) mechanistic understanding of the biochemical processes related to diabetes; (b) diabetes self-management knowledge; and (c) glycemic control. We hypothesized that learning with such simulations might support adolescents in gaining a better understanding of the biochemical processes related to glucose regulation, and consequently improve their glycemic control.


A prospective case-control study was conducted in 12- to 18-year-old adolescents with T1DM (n = 85) who were routinely treated at an outpatient diabetes clinic. While the control group (n = 45) received the routine face-to-face follow-up, the intervention group (n = 40) learned in addition with computerized simulations that were embedded in pedagogically supportive activities. Participants in both groups completed a set of questionnaires regarding sociodemographic characteristics, diabetes mechanistic reasoning and diabetes self-management. Clinical data and serum glycated hemoglobin (HbA1c) levels were gathered from medical records. All the data was collected at recruitment and 3 months later.


Analysis revealed improvement HbA1c levels in the intervention group (8.7% ± 1.7%) vs the controls (9.6% ± 1.6%) after 3 months (P < .05). Regression analysis showed that levels of diabetes mechanistic understanding and diabetes self-management knowledge, in addition to sociodemographic parameters, accounted for 31% of the HbA1c variance (P < .001).


These results suggest that learning with computerized simulations about biochemical processes can improve adolescents' adherence to medical recommendations and result in improved glycemic control. Implementing scientific learning into the hospital educational setting is discussed.


adherence; adolescence; agent-based models; computer-based simulations; patient education; type 1 diabetes mellitus


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