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Research Summary
Analyzed using Evidence Intelligence™

Game-based education improves treatment compliance and reduces anxiety in diabetes.

Powered by the Dediabetes Evidence Intelligence™ framework

Last updated September 9, 2026

Key finding

Adjusted Mean Difference clearly (95% CI) -22.94 [−28.61, −17.27]

This study compared game-based education to standard lecture-based education for individuals starting insulin therapy, finding significant differences in treatment compliance and anxiety levels.

Quick read

Study at a glance

The essential study design details in one scan.

EvidenceScore™

Moderate

Study type

RCTs

Follow-up

Short-Term (≤3 mo)

Risk of bias

Some Concerns

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Plain-language summary

What this paper says

A plain-language read of the study’s main message and where it applies.

Study focus

This study compared game-based education to standard lecture-based education for individuals starting insulin therapy, finding significant differences in treatment compliance and anxiety levels.

Clinical relevance

Improving treatment compliance and reducing anxiety are crucial for individuals initiating insulin therapy, as these factors can significantly impact health outcomes. This study suggests that innovative educational approaches, like game-based learning, could be more effective in supporting patients during this critical transition.

Keep in mind

The study had unclear effectiveness for some outcomes. Results may not be generalizable beyond the studied population. Sample size and demographic diversity were not specified. Potential confounding factors were not fully controlled.

Published in

Journal Reference

Publication details and source links for this paper.

Esin E, Gönül D, Stefano T. Game-based education is more effective than standard lecture-based education in enhancing treatment compliance and reducing anxiety among individuals initiating insulin therapy. PLOS One. 2026;21(3):e0345292. doi:10.1371/journal.pone.0345292

View DOIView on PubMedView on PMC

Main Effects

Game-based education led to a 22.94 point increase in treatment compliance (p = 0.001).

Participants in the game-based group experienced a 7.04 point decrease in anxiety scores (p = 0.001).

No significant difference in treatment compliance was observed between groups for some outcomes.

No significant difference in anxiety levels was found between the intervention and control groups for certain analyses.

Evidence network

How this study fits

Understand where this research contributes within the broader evidence network.

Evidence Context

This study contributes evidence to Game-based education program, Standard lecture-based education and Anxiety, Treatment adherence.

This study contributes evidence to

Intervention

Game-based education program

Outcome

Anxiety

Evidence topic

Treatment Adherence

Primary intervention

Game-based education program

Primary outcomes

  • Anxiety
  • Treatment adherence

Evidence topics

Treatment Adherence

Primary intervention

Game-based education program

Primary outcomes

AnxietyTreatment adherence

Evidence relationships

Intervention and outcome relationships this study adds to the evidence network.

4
Evidence pairs
4
Relationships
1
Evidence topics
contributes_evidence

Editorial context

Why this study matters

See why this paper is useful beyond its individual results.

Evidence network role

This section describes how the study fits into the current evidence network. It does not determine whether an intervention works on its own.

Moderate contributionModerate confidenceNetwork score: 63

1

Related topics

4

Evidence pairs

108

Related studies

High relevance in at least one topic

Why it is useful

  • Contributes to 4 evidence relationships
  • Includes primary outcome data
  • Linked to 1 direct semantic evidence topic

Topic contributions

Evidence topic

Contributes evidence

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Primary evidence

Evidence topic

Treatment Adherence

matched_outcome

Core evidence

Study findings

The primary outcomes reported in this study.

Anxiety

Game-based education program → Anxiety

Game-based education program → Anxiety

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
100
Very Positive
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Treatment adherence

Game-based education program → Treatment adherence

Game-based education program → Treatment adherence

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
100
Very Positive
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Anxiety

Standard lecture-based education → Anxiety

Standard lecture-based education → Anxiety

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
50
Neutral
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Treatment adherence

Standard lecture-based education → Treatment adherence

Standard lecture-based education → Treatment adherence

Evidence Intelligence™
EvidenceScore™
Emerging
Score 59 · Based on 1 study
ImpactScore™
50
Neutral
ConsistencyScore™
unclear
Not enough independent studies
Supporting studies: Based on 1 study
Add to Evidence Tracker

Evidence Library

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evidence suggest

Evidence Suggest

  • Game-based education improved treatment compliance by 22.94 points.
  • Anxiety scores decreased by 7.04 points in the game-based group.
  • Some outcomes showed no significant differences between groups.
who this applies

Who this applies to

  • Individuals initiating insulin therapy.
  • Patients with diabetes seeking improved treatment compliance.
  • Adults and adolescents learning about insulin management.
keep in mind

Keep in Mind

  • The effectiveness of game-based education remains unclear for some outcomes.
  • Results may not apply to all demographics or settings.
  • Further research is needed to confirm findings and explore long-term impacts.
between the lines

Between the Lines

  • The study had unclear effectiveness for some outcomes.
  • Results may not be generalizable beyond the studied population.
  • Sample size and demographic diversity were not specified.
  • Potential confounding factors were not fully controlled.

Evidence Library

Build your evidence library

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Connected Evidence

Explore related studies, evidence collections, and research questions.

Relationships organized using the Dediabetes Evidence Intelligence™ framework.

Powered by the Dediabetes Evidence Intelligence™ framework

This study contributes to evidence on Game-based education program and Anxiety, Game-based education program and Treatment Adherence.

Related evidence relationships

Explore in Evidence Explorer

This study contributes to the evidence on the following intervention-outcome relationships.

Questions answered by this study

Generated from the study's connected evidence using Evidence Intelligence™.

Does Game-based education program improve anxiety?

Emerging Evidence

Game-based education program appears to improve anxiety.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Anxiety

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does Game-based education program improve treatment adherence?

Emerging Evidence

Game-based education program appears to improve treatment adherence.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Treatment adherence

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | strong positive | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does Standard lecture-based education improve anxiety?

Emerging Evidence

Current evidence does not show a clear benefit of Standard lecture-based education for anxiety.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Anxiety

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence

Does Standard lecture-based education improve treatment adherence?

Emerging Evidence

Current evidence does not show a clear benefit of Standard lecture-based education for treatment adherence.

ConsistencyScore™: Consistency cannot yet be determined from the available evidence.

Ranked evidence signals

  1. 1

    Treatment adherence

    EvidenceScore™ Emerging | EvidenceScore™ 59.0 | neutral | ConsistencyScore™ Unclear | 1 study

Why this answer: This answer is based on a single supporting study.

Limitations

  • Only one supporting study is available.
1 supporting study
View Full Evidence
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Next steps

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Evidence topics

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Treatment Adherence Evidence Hub

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All studies on Game-based education program and Treatment adherenceAll studies on Standard lecture-based education and Treatment adherenceAll studies on Game-based education program and AnxietyAll studies on Standard lecture-based education and Anxiety

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