Introduction and Objective: Type 2 diabetes (T2DM) places older adults at risk of unhealthy aging and cognitive decline. Diabetes self-management education and support (DSME/S) is effective but underutilized. We conducted a two-arm randomized trial (DSME/S delivery via an immersive, 3D virtual environment (HOPE) versus a waitlist control group) to assess 6-month changes in glucose control (HbA1c) and Diabetes Distress Scale (DDS)-17 scores.Methods: English-speaking older adults (aged 65+) with uncontrolled T2DM (HbA1c ≥7.5%) and access to (or willingness to use) an Internet-enabled device were enrolled. Data collection occurred at baseline, 3 months, and 6 months via medical records or point-of-care tests (for HbA1c) and patient-reported surveys (for DDS-17). HOPE participants accessed an avatar-driven immersive virtual landscape and joined weekly group-based gamified DSME/S sessions, while waitlist participants continued usual care for 6 months. Changes in primary outcomes were assessed using paired t-tests and OLS regression to control for unbalanced covariates.Results: A total of 130 participants enrolled (mean age: 71 years, 58% female, 75% White, 95% non-Hispanic, 78% retired or unemployed, 88% on Medicare, and 83% college-educated). The HOPE group significantly improved mean HbA1c relative to waitlist [n=103, -0.9% (1.2) vs -0.3% (1.4), p=0.023] at 6 months. HOPE also outperformed the waitlist group on DDS [n=85, -0.6 (0.7) vs 0.1 (0.5), p<0.001] and subdomain scores for emotional burden (p<0.001), interpersonal (p< 0.001), regimen-related (p=0.005) and physician-related (p=0.033) distress.Conclusion: Gamified DSME/S is associated with clinical and psychosocial improvements among older adults.
S. Mitchell: Stock/Shareholder; Current; See Yourself Health LLC. B.A. De La Cruz: None. R.I. Harris: None. G. Asante: None. B. Linney: None. S. Greisner: None. R. Capelson: None. M.J. Reichert: None.
National Institutes of Health (R44AG072990)
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