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Case 6–2020: A 34-Year-Old Woman with Hyperglycemia

Presentation of case.

Dr. Max C. Petersen (Medicine): A 34-year-old woman was evaluated in the diabetes clinic of this hospital for hyperglycemia.

Eleven years before this presentation, the blood glucose level was 126 mg per deciliter (7.0 mmol per liter) on routine laboratory evaluation, which was performed as part of an annual well visit. The patient could not recall whether she had been fasting at the time the test had been performed. One year later, the fasting blood glucose level was 112 mg per deciliter (6.2 mmol per liter; reference range, <100 mg per deciliter [<5.6 mmol per liter]).

Nine years before this presentation, a randomly obtained blood glucose level was 217 mg per deciliter (12.0 mmol per liter), and the patient reported polyuria. At that time, the glycated hemoglobin level was 5.8% (reference range, 4.3 to 5.6); the hemoglobin level was normal. One year later, the glycated hemoglobin level was 5.9%. The height was 165.1 cm, the weight 72.6 kg, and the body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) 26.6. The patient received a diagnosis of prediabetes and was referred to a nutritionist. She made changes to her diet and lost 4.5 kg of body weight over a 6-month period; the glycated hemoglobin level was 5.5%.

Six years before this presentation, the patient became pregnant with her first child. Her prepregnancy BMI was 24.5. At 26 weeks of gestation, the result of a 1-hour oral glucose challenge test (i.e., the blood glucose level obtained 1 hour after the oral administration of a 50-g glucose load in the nonfasting state) was 186 mg per deciliter (10.3 mmol per liter; reference range, <140 mg per deciliter [<7.8 mmol per liter]). She declined a 3-hour oral glucose tolerance test; a presumptive diagnosis of gestational diabetes was made. She was asked to follow a meal plan for gestational diabetes and was treated with insulin during the pregnancy. Serial ultrasound examinations for fetal growth and monitoring were performed. At 34 weeks of gestation, the fetal abdominal circumference was in the 76th percentile for gestational age. Polyhydramnios developed at 37 weeks of gestation. The child was born at 39 weeks 3 days of gestation, weighed 3.9 kg at birth, and had hypoglycemia after birth, which subsequently resolved. Six weeks post partum, the patient’s fasting blood glucose level was 120 mg per deciliter (6.7 mmol per liter), and the result of a 2-hour oral glucose tolerance test (i.e., the blood glucose level obtained 2 hours after the oral administration of a 75-g glucose load in the fasting state) was 131 mg per deciliter (7.3 mmol per liter; reference range, <140 mg per deciliter). Three months post partum, the glycated hemoglobin level was 6.1%. Lifestyle modification for diabetes prevention was recommended.

Four and a half years before this presentation, the patient became pregnant with her second child. Her prepregnancy BMI was 25.1. At 5 weeks of gestation, she had an elevated blood glucose level. Insulin therapy was started at 6 weeks of gestation, and episodes of hypoglycemia occurred during the pregnancy. Serial ultrasound examinations for fetal growth and monitoring were performed. At 28 weeks of gestation, the fetal abdominal circumference was in the 35th percentile for gestational age, and the amniotic fluid level was normal. Labor was induced at 38 weeks of gestation; the child weighed 2.6 kg at birth. Neonatal blood glucose levels were reported as stable after birth. Six weeks post partum, the patient’s fasting blood glucose level was 133 mg per deciliter (7.4 mmol per liter), and the result of a 2-hour oral glucose tolerance test was 236 mg per deciliter (13.1 mmol per liter). The patient received a diagnosis of type 2 diabetes mellitus; lifestyle modification was recommended. Three months post partum, the glycated hemoglobin level was 5.9% and the BMI was 30.0. Over the next 2 years, she followed a low-carbohydrate diet and regular exercise plan and self-monitored the blood glucose level.

Two years before this presentation, the patient became pregnant with her third child. Blood glucose levels were again elevated, and insulin therapy was started early in gestation. She had episodes of hypoglycemia that led to adjustment of her insulin regimen. The child was born at 38 weeks 5 days of gestation, weighed 3.0 kg at birth, and had hypoglycemia that resolved 48 hours after birth. After the birth of her third child, the patient started to receive metformin, which had no effect on the glycated hemoglobin level, despite adjustment of the therapy to the maximal dose.

One year before this presentation, the patient became pregnant with her fourth child. Insulin therapy was again started early in gestation. The patient reported that episodes of hypoglycemia occurred. Polyhydramnios developed. The child was born at 38 weeks 6 days of gestation and weighed 3.5 kg. The patient sought care at the diabetes clinic of this hospital for clarification of her diagnosis.

The patient reported following a low-carbohydrate diet and exercising 5 days per week. There was no fatigue, change in appetite, change in vision, chest pain, shortness of breath, polydipsia, or polyuria. There was no history of anemia, pancreatitis, hirsutism, proximal muscle weakness, easy bruising, headache, sweating, tachycardia, gallstones, or diarrhea. Her menstrual periods were normal. She had not noticed any changes in her facial features or the size of her hands or feet.

The patient had a history of acne and low-back pain. Her only medication was metformin. She had no known medication allergies. She lived with her husband and four children in a suburban community in New England and worked as an administrator. She did not smoke tobacco or use illicit drugs, and she rarely drank alcohol. She identified as non-Hispanic white. Both of her grandmothers had type 2 diabetes mellitus. Her father had hypertension, was overweight, and had received a diagnosis of type 2 diabetes at 50 years of age. Her mother was not overweight and had received a diagnosis of type 2 diabetes at 48 years of age. The patient had two sisters, neither of whom had a history of diabetes or gestational diabetes. There was no family history of hemochromatosis.

On examination, the patient appeared well. The blood pressure was 126/76 mm Hg, and the heart rate 76 beats per minute. The BMI was 25.4. The physical examination was normal. The glycated hemoglobin level was 6.2%.

A diagnostic test was performed.

DIFFERENTIAL DIAGNOSIS

Dr. Miriam S. Udler: I am aware of the diagnosis in this case and participated in the care of this patient. This healthy 34-year-old woman, who had a BMI just above the upper limit of the normal range, presented with a history of hyperglycemia of varying degrees since 24 years of age. When she was not pregnant, she was treated with lifestyle measures as well as metformin therapy for a short period, and she maintained a well-controlled blood glucose level. In thinking about this case, it is helpful to characterize the extent of the hyperglycemia and then to consider its possible causes.

CHARACTERIZING HYPERGLYCEMIA

This patient’s hyperglycemia reached a threshold that was diagnostic of diabetes 1 on two occasions: when she was 25 years of age, she had a randomly obtained blood glucose level of 217 mg per deciliter with polyuria (with diabetes defined as a level of ≥200 mg per deciliter [≥11.1 mmol per liter] with symptoms), and when she was 30 years of age, she had on the same encounter a fasting blood glucose level of 133 mg per deciliter (with diabetes defined as a level of ≥126 mg per deciliter) and a result on a 2-hour oral glucose tolerance test of 236 mg per deciliter (with diabetes defined as a level of ≥200 mg per deciliter). On both of these occasions, her glycated hemoglobin level was in the prediabetes range (defined as 5.7 to 6.4%). In establishing the diagnosis of diabetes, the various blood glucose studies and glycated hemoglobin testing may provide discordant information because the tests have different sensitivities for this diagnosis, with glycated hemoglobin testing being the least sensitive. 2 Also, there are situations in which the glycated hemoglobin level can be inaccurate; for example, the patient may have recently received a blood transfusion or may have a condition that alters the life span of red cells, such as anemia, hemoglobinopathy, or pregnancy. 3 These conditions were not present in this patient at the time that the glycated hemoglobin measurements were obtained. In addition, since the glycated hemoglobin level reflects the average glucose level typically over a 3-month period, discordance with timed blood glucose measurements can occur if there has been a recent change in glycemic control. This patient had long-standing mild hyperglycemia but met criteria for diabetes on the basis of the blood glucose levels noted.

Type 1 and Type 2 Diabetes

Now that we have characterized the patient’s hyperglycemia as meeting criteria for diabetes, it is important to consider the possible types. More than 90% of adults with diabetes have type 2 diabetes, which is due to progressive loss of insulin secretion by beta cells that frequently occurs in the context of insulin resistance. This patient had received a diagnosis of type 2 diabetes; however, some patients with diabetes may be given a diagnosis of type 2 diabetes on the basis of not having features of type 1 diabetes, which is characterized by autoimmune destruction of the pancreatic beta cells that leads to rapid development of insulin dependence, with ketoacidosis often present at diagnosis.

Type 1 diabetes accounts for approximately 6% of all cases of diabetes in adults (≥18 years of age) in the United States, 4 and 80% of these cases are diagnosed before the patient is 20 years of age. 5 Since this patient’s diabetes was essentially nonprogressive over a period of at least 9 years, she most likely does not have type 1 diabetes. It is therefore not surprising that she had received a diagnosis of type 2 diabetes, but there are several other types of diabetes to consider, particularly since some features of her case do not fit with a typical case of type 2 diabetes, such as her age at diagnosis, the presence of hyperglycemia despite a nearly normal BMI, and the mild and nonprogressive nature of her disease over the course of many years.

Less Common Types of Diabetes

Latent autoimmune diabetes in adults (LADA) is a mild form of autoimmune diabetes that should be considered in this patient. However, there is controversy as to whether LADA truly represents an entity that is distinct from type 1 diabetes. 6 Both patients with type 1 diabetes and patients with LADA commonly have elevated levels of diabetes-associated autoantibodies; however, LADA has been defined by an older age at onset (typically >25 years) and slower progression to insulin dependence (over a period of >6 months). 7 This patient had not been tested for diabetes-associated autoantibodies. I ordered these tests to help evaluate for LADA, but this was not my leading diagnosis because of her young age at diagnosis and nonprogressive clinical course over a period of at least 9 years.

If the patient’s diabetes had been confined to pregnancy, we might consider gestational diabetes, but she had hyperglycemia outside of pregnancy. Several medications can cause hyperglycemia, including glucocorticoids, atypical antipsychotic agents, cancer immunotherapies, and some antiretroviral therapies and immunosuppressive agents used in transplantation. 8 However, this patient was not receiving any of these medications. Another cause of diabetes to consider is destruction of the pancreas due to, for example, cystic fibrosis, a tumor, or pancreatitis, but none of these were present. Secondary endocrine disorders — including excess cortisol production, excess growth hormone production, and pheochromocytoma — were considered to be unlikely in this patient on the basis of the history, review of symptoms, and physical examination.

Monogenic Diabetes

A final category to consider is monogenic diabetes, which is caused by alteration of a single gene. Types of monogenic diabetes include maturity-onset diabetes of the young (MODY), neonatal diabetes, and syndromic forms of diabetes. Monogenic diabetes accounts for 1 to 6% of cases of diabetes in children 9 and approximately 0.4% of cases in adults. 10 Neonatal diabetes is diagnosed typically within the first 6 months of life; syndromic forms of monogenic diabetes have other abnormal features, including particular organ dysfunction. Neither condition is applicable to this patient.

MODY is an autosomal dominant condition characterized by primary pancreatic beta-cell dysfunction that causes mild diabetes that is diagnosed during adolescence or early adulthood. As early as 1964, the nomenclature “maturity-onset diabetes of the young” was used to describe cases that resembled adult-onset type 2 diabetes in terms of the slow progression to insulin use (as compared with the rapid progression in type 1 diabetes) but occurred in relatively young patients. 11 Several genes cause distinct forms of MODY that have specific disease features that inform treatment, and thus MODY is a clinically important diagnosis. Most forms of MODY cause isolated abnormal glucose levels (in contrast to syndromic monogenic diabetes), a manifestation that has contributed to its frequent misdiagnosis as type 1 or type 2 diabetes. 12

Genetic Basis of MODY

Although at least 13 genes have been associated with MODY, 3 genes — GCK , which encodes glucokinase, and HNF1A and HNF4A , which encode hepatocyte nuclear factors 1A and 4A, respectively — account for most cases. MODY associated with GCK (known as GCK-MODY) is characterized by mild, nonprogressive hyperglycemia that is present since birth, whereas the forms of MODY associated with HNF1A and HNF4A (known as HNF1A-MODY and HNF4A-MODY, respectively) are characterized by the development of diabetes, typically in the early teen years or young adulthood, that is initially mild and then progresses such that affected patients may receive insulin before diagnosis.

In patients with GCK-MODY, genetic variants reduce the function of glucokinase, the enzyme in pancreatic beta cells that functions as a glucose sensor and controls the rate of entry of glucose into the glycolytic pathway. As a result, reduced sensitivity to glucose-induced insulin secretion causes asymptomatic mild fasting hyperglycemia, with an upward shift in the normal range of the fasting blood glucose level to 100 to 145 mg per deciliter (5.6 to 8.0 mmol per liter), and also causes an upward shift in postprandial blood glucose levels, but with tight regulation maintained ( Fig. 1 ). 13 This mild hyperglycemia is not thought to confer a predisposition to complications of diabetes, 14 is largely unaltered by treatment, 15 and does not necessitate treatment outside of pregnancy.

Key features suggesting maturity-onset diabetes of the young (MODY) in this patient were an age of less than 35 years at the diagnosis of diabetes, a strong family history of diabetes with an autosomal dominant pattern of inheritance, and hyperglycemia despite a close-to-normal body-mass index. None of these features is an absolute criterion. MODY is caused by single gene–mediated disruption of pancreatic beta-cell function. In MODY associated with the GCK gene (known as GCK-MODY), disrupted glucokinase function causes a mild upward shift in glucose levels through-out the day and does not necessitate treatment. 13 In the pedigree, circles represent female family members, squares male family members, blue family members affected by diabetes, and green unaffected family members. The arrow indicates the patient.

In contrast to GCK-MODY, the disorders HNF1A-MODY and HNF4A-MODY result in progressive hyperglycemia that eventually leads to treatment. 16 Initially, there may be a normal fasting glucose level and large spikes in postprandial glucose levels (to >80 mg per deciliter [>4.4 mmol per liter]). 17 Patients can often be treated with oral agents and discontinue insulin therapy started before the diagnosis of MODY. 18 Of note, patients with HNF1A-MODY or HNF4A-MODY are typically sensitive to treatment with sulfonylureas 19 but may also respond to glucagon-like peptide-1 receptor agonists. 20

This patient had received a diagnosis of diabetes before 35 years of age, had a family history of diabetes involving multiple generations, and was not obese. These features are suggestive of MODY but do not represent absolute criteria for the condition ( Fig. 1 ). 1 Negative testing for diabetes-associated autoantibodies would further increase the likelihood of MODY. There are methods to calculate a patient’s risk of having MODY associated with GCK , HNF1A , or HNF4A . 21 , 22 Using an online calculator ( www.diabetesgenes.org/mody-probability-calculator ), we estimate that the probability of this patient having MODY is at least 75.5%. Genetic testing would be needed to confirm this diagnosis, and in patients at an increased risk for MODY, multigene panel testing has been shown to be cost-effective. 23 , 24

DR. MIRIAM S. UDLER’S DIAGNOSIS

Maturity-onset diabetes of the young, most likely due to a GCK variant.

DIAGNOSTIC TESTING

Dr. Christina A. Austin-Tse: A diagnostic sequencing test of five genes associated with MODY was performed. One clinically significant variant was identified in the GCK gene ( {"type":"entrez-nucleotide","attrs":{"text":"NM_000162.3","term_id":"167621407","term_text":"NM_000162.3"}} NM_000162.3 ): a c.787T→C transition resulting in the p.Ser263Pro missense change. Review of the literature and variant databases revealed that this variant had been previously identified in at least three patients with early-onset diabetes and had segregated with disease in at least three affected members of two families (GeneDx: personal communication). 25 , 26 Furthermore, the variant was rare in large population databases (occurring in 1 out of 128,844 European chromosomes in gnomAD 27 ), a feature consistent with a disease-causing role. Although the serine residue at position 263 was not highly conserved, multiple in vitro functional studies have shown that the p.Ser263Pro variant negatively affects the stability of the glucokinase enzyme. 26 , 28 – 30 As a result, this variant met criteria to be classified as “likely pathogenic.” 31 As mentioned previously, a diagnosis of GCK-MODY is consistent with this patient’s clinical features. On subsequent testing of additional family members, the same “likely pathogenic” variant was identified in the patient’s father and second child, both of whom had documented hyperglycemia.

DISCUSSION OF MANAGEMENT

Dr. Udler: In this patient, the diagnosis of GCK-MODY means that it is normal for her blood glucose level to be mildly elevated. She can stop taking metformin because discontinuation is not expected to substantially alter her glycated hemoglobin level 15 , 32 and because she is not at risk for complications of diabetes. 14 However, she should continue to maintain a healthy lifestyle. Although patients with GCK-MODY are not typically treated for hyperglycemia outside of pregnancy, they may need to be treated during pregnancy.

It is possible for a patient to have type 1 or type 2 diabetes in addition to MODY, so this patient should be screened for diabetes according to recommendations for the general population (e.g., in the event that she has a risk factor for diabetes, such as obesity). 1 Since the mild hyperglycemia associated with GCK-MODY is asymptomatic (and probably unrelated to the polyuria that this patient had described in the past), the development of symptoms of hyperglycemia, such as polyuria, polydipsia, or blurry vision, should prompt additional evaluation. In patients with GCK-MODY, the glycated hemoglobin level is typically below 7.5%, 33 so a value rising above that threshold or a sudden large increase in the glycated hemoglobin level could indicate concomitant diabetes from another cause, which would need to be evaluated and treated.

This patient’s family members are at risk for having the same GCK variant, with a 50% chance of offspring inheriting a variant from an affected parent. Since the hyperglycemia associated with GCK-MODY is present from birth, it is necessary to perform genetic testing only in family members with demonstrated hyperglycemia. I offered site-specific genetic testing to the patient’s parents and second child.

Dr. Meridale V. Baggett (Medicine): Dr. Powe, would you tell us how you would treat this patient during pregnancy?

Dr. Camille E. Powe: During the patient’s first pregnancy, routine screening led to a presumptive diagnosis of gestational diabetes, the most common cause of hyperglycemia in pregnancy. Hyperglycemia in pregnancy is associated with adverse pregnancy outcomes, 34 and treatment lowers the risk of such outcomes. 35 , 36 Two of the most common complications — fetal overgrowth (which can lead to birth injuries, shoulder dystocia, and an increased risk of cesarean delivery) and neonatal hypoglycemia — are thought to be the result of fetal hyperinsulinemia. 37 Maternal glucose is freely transported across the placenta, and excess glucose augments insulin secretion from the fetal pancreas. In fetal life, insulin is a potent growth factor, and neonates who have hyperinsulinemia in utero often continue to secrete excess insulin in the first few days of life. In the treatment of pregnant women with diabetes, we strive for strict blood sugar control (fasting blood glucose level, <95 mg per deciliter [<5.3 mmol per liter]; 2-hour postprandial blood glucose level, <120 mg per deciliter) to decrease the risk of these and other hyperglycemia-associated adverse pregnancy outcomes. 38 – 40

In the third trimester of the patient’s first pregnancy, obstetrical ultrasound examination revealed a fetal abdominal circumference in the 76th percentile for gestational age and polyhydramnios, signs of fetal exposure to maternal hyperglycemia. 40 – 42 Case series involving families with GCK-MODY have shown that the effect of maternal hyperglycemia on the fetus depends on whether the fetus inherits the pathogenic GCK variant. 43 – 48 Fetuses that do not inherit the maternal variant have overgrowth, presumably due to fetal hyperinsulinemia ( Fig. 2A ). In contrast, fetuses that inherit the variant do not have overgrowth and are born at a weight that is near the average for gestational age, despite maternal hyperglycemia, presumably because the variant results in decreased insulin secretion ( Fig. 2B ). Fetuses that inherit GCK-MODY from their fathers and have euglycemic mothers appear to be undergrown, most likely because their insulin secretion is lower than normal when they and their mothers are euglycemic ( Fig. 2D ). Because fetal overgrowth and polyhydramnios occurred during this patient’s first pregnancy and neonatal hypoglycemia developed after the birth, the patient’s first child is probably not affected by GCK-MODY.

Pathogenic variants that lead to GCK-MODY, when carried by a fetus, change the usual relationship of maternal hyperglycemia to fetal hyperinsulinemia and fetal overgrowth. GCK-MODY–affected fetuses have lower insulin secretion than unaffected fetuses in response to the same maternal blood glucose level. In a hyperglycemic mother carrying a fetus who is unaffected by GCK-MODY, excessive fetal growth is usually apparent (Panel A). Studies involving GCK-MODY–affected hyperglycemic mothers have shown that fetal growth is normal despite maternal hyperglycemia when a fetus has the maternal GCK variant (Panel B). The goal of treatment of maternal hyperglycemia when a fetus is unaffected by GCK-MODY is to establish euglycemia to normalize fetal insulin levels and growth (Panel C); whether this can be accomplished in the case of maternal GCK-MODY is controversial, given the genetically determined elevated maternal glycemic set point. In the context of maternal euglycemia, GCK-MODY–affected fetuses may be at risk for fetal growth restriction (Panel D).

In accordance with standard care for pregnant women with diabetes who do not meet glycemic targets after dietary modification, 38 , 39 the patient was treated with insulin during her pregnancies. In her second pregnancy, treatment was begun early, after hyperglycemia was detected in the first trimester. Because she had not yet received the diagnosis of GCK-MODY during any of her pregnancies, no consideration of this condition was given during her obstetrical treatment. Whether treatment affects the risk of hyperglycemia-associated adverse pregnancy outcomes in pregnant women with known GCK-MODY is controversial, with several case series showing that the birth weight percentile in unaffected neonates remains consistent regardless of whether the mother is treated with insulin. 44 , 45 Evidence suggests that it may be difficult to overcome a genetically determined glycemic set point in patients with GCK-MODY with the use of pharmacotherapy, 15 , 32 and affected patients may have symptoms of hypoglycemia when the blood glucose level is normal because of an enhanced counterregulatory response. 49 , 50 Still, to the extent that it is possible, it would be desirable to safely lower the blood glucose level in a woman with GCK-MODY who is pregnant with an unaffected fetus in order to decrease the risk of fetal overgrowth and other consequences of mildly elevated glucose levels ( Fig. 2C ). 46 , 47 , 51 In contrast, there is evidence that lowering the blood glucose level in a pregnant woman with GCK-MODY could lead to fetal growth restriction if the fetus is affected ( Fig. 2D ). 45 , 52 During this patient’s second pregnancy, she was treated with insulin beginning in the first trimester, and her daughter’s birth weight was near the 16th percentile for gestational age; this outcome is consistent with the daughter’s ultimate diagnosis of GCK-MODY.

Expert opinion suggests that, in pregnant women with GCK-MODY, insulin therapy should be deferred until fetal growth is assessed by means of ultrasound examination beginning in the late second trimester. If there is evidence of fetal overgrowth, the fetus is presumed to be unaffected by GCK-MODY and insulin therapy is initiated. 53 After I have counseled women with GCK-MODY on the potential risks and benefits of insulin treatment during pregnancy, I have sometimes used a strategy of treating hyperglycemia from early in pregnancy using modified glycemic targets that are less stringent than the targets typically used during pregnancy. This strategy attempts to balance the risk of growth restriction in an affected fetus (as well as maternal hypoglycemia) with the potential benefit of glucose-lowering therapy for an unaffected fetus.

Dr. Udler: The patient stopped taking metformin, and subsequent glycated hemoglobin levels remained unchanged, at 6.2%. Her father and 5-year-old daughter (second child) both tested positive for the same GCK variant. Her father had a BMI of 36 and a glycated hemoglobin level of 7.8%, so I counseled him that he most likely had type 2 diabetes in addition to GCK-MODY. He is currently being treated with metformin and lifestyle measures. The patient’s daughter now has a clear diagnosis to explain her hyperglycemia, which will help in preventing misdiagnosis of type 1 diabetes, given her young age, and will be important for the management of any future pregnancies. She will not need any medical follow-up for GCK-MODY until she is considering pregnancy.

FINAL DIAGNOSIS

Maturity-onset diabetes of the young due to a GCK variant.

Acknowledgments

We thank Dr. Andrew Hattersley and Dr. Sarah Bernstein for helpful comments on an earlier draft of the manuscript.

This case was presented at the Medical Case Conference.

No potential conflict of interest relevant to this article was reported.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org .

6 Ways to Teach Diabetes to Nursing Students

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Diabetes, a chronic condition affecting approximately 8% of the global population, and nearly 30% of Americans age 65 or older, is something that nurses will often encounter. For nursing students, learning the complexities of diabetes care is crucial, as they are on the front lines of patient interaction and management. 

Effective teaching strategies are essential to bridge the gap between theoretical knowledge and practical skills. Here are six active learning approaches to teaching diabetes to nursing students, enhancing their learning experience, and preparing them for real-world challenges.

1. Low-Fidelity Simulations

These simulations involve the use of basic tools and resources to mimic real-life scenarios, providing students with a hands-on learning experience that enhances their understanding of how to manage diabetes in clinical settings. By incorporating low-fidelity simulations into their education, nursing students can practice assessing blood sugar levels, administering insulin, and responding to low blood glucose episodes in a controlled environment. 

Realityworks Diabetes Education Kit is an example.

2. Gamification Techniques

Gamification introduces the elements of game playing, such as scoring points, competing with others, and following rules, into the educational process to enhance engagement and motivation. By incorporating gamification in diabetes education, complex concepts can be simplified, making learning both fun and effective. 

There's a game called “ Candy Gland ” that nurse educators can use. “This educational game effectively improved student knowledge and confidence in diabetes diagnosis, pharmacology, and management in an engaging, unique session.” 

3. Immersive Virtual Reality (VR) Tools

Leveraging immersive VR tools offers nursing students a unique opportunity to step into the shoes of a nurse. UbiSim is a VR platform built just for nurses by nurse educators. Through any of the four diabetes simulations in the UbiSim catalog, students can experience the management of diabetes in a controlled yet realistic environment. They can make mistakes in VR so that they don't make them in a clinical setting. 

Utilizing VR even helps prepare learners for the Next Gen NCLEX by boosting their clinical judgment skills. They have to decide what to do next, such as administering insulin or assuring the stressed patient that they'll be okay. VR is a great way to practice handling difficult conversations, such as discussing lifestyle changes or the importance of adherence to treatment plans.

Request a demo of UbiSim today to help your nurse learners step into the shoes of a real nurse!

4. Role-Playing Scenarios

Role-playing is a dynamic teaching strategy that allows nursing students to practice communication, clinical decision-making, and patient education in a safe and supportive environment. By taking on roles such as the nurse, patient, or family member, students can explore different perspectives on diabetes management. 

This approach helps students develop empathy and improve their ability to educate and support patients in managing their diabetes. 

5. Case Studies

Case studies are an effective way to connect theoretical knowledge with clinical practice. By analyzing real scenarios, students can apply their learning to diagnose, manage, and provide holistic care to patients with diabetes. 

This method encourages critical thinking, clinical reasoning, and evidence-based practice. Case studies can be presented in various formats, such as written documents, videos, or interactive discussions, providing a comprehensive understanding of the challenges and complexities involved in diabetes care.

6. Connecting Topics to Real-world Scenarios

Integrating real-world scenarios into the curriculum ensures that nursing students can relate theoretical knowledge to practical applications. This can be achieved through guest lectures from diabetes care specialists, or just thinking about a person in their life who has diabetes. 

Such experiences enable students to observe and understand the impact of diabetes on individuals and communities, reinforcing the importance of patient-centered care and public health education. Connecting learning to real-world situations prepares students for the realities of nursing practice and the role they will play in managing and preventing diabetes.

Final Thoughts

Educating nursing students on diabetes through innovative teaching strategies is vital in preparing them for the complexities of healthcare delivery. Educators can enhance active learning experiences, foster critical thinking, and equip students with the skills necessary to provide exceptional care to patients with diabetes. These approaches not only improve knowledge and practical skills but also emphasize the importance of empathy, communication, and patient education in managing chronic conditions like diabetes.

As an integral center of UbiSim's content team, Ginelle pens stories on the rapidly changing landscape of VR in nursing simulation. Ginelle is committed to elevating the voices of practicing nurses, nurse educators, and program leaders who are making a difference.

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• Diabetes & Primary Care
• Vol:23 | No:02

Interactive case study: Making a diagnosis of type 2 diabetes

• 12 Apr 2021

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Diabetes & Primary Care ’s series of interactive case studies is aimed at GPs, practice nurses and other professionals in primary and community care who would like to broaden their understanding of type 2 diabetes.

The three mini-case studies presented with this issue of the journal take you through what to consider in making an accurate diagnosis of type 2 diabetes.

The format uses typical clinical scenarios as tools for learning. Information is provided in short sections, with most ending in a question to answer before moving on to the next section.

Working through the case studies will improve your knowledge and problem-solving skills in type 2 diabetes by encouraging you to make evidence-based decisions in the context of individual cases.

Crucially, you are invited to respond to the questions by typing in your answers. In this way, you are actively involved in the learning process, which is a much more effective way to learn.

By actively engaging with these case histories, I hope you will feel more confident and empowered to manage such presentations effectively in the future.

Colin is a 51-year-old construction worker. A recent blood test shows an HbA 1c of 67 mmol/mol. Is this result enough to make a diagnosis of diabetes?

Rao, a 42-year-old accountant of Asian origin, is currently asymptomatic but has a strong family history of type 2 diabetes. Tests have revealed a fasting plasma glucose level of 6.7 mmol/L and an HbA 1c of 52 mmol/mol. How would you interpret these results?

43-year-old Rachael has complained of fatigue. She has a BMI of 28.4 kg/m 2 and her mother has type 2 diabetes. Rachael’s HbA 1c is 46 mmol/mol. How would you interpret her HbA 1c measurement?

By working through these interactive cases, you will consider the following issues and more:

• The criteria for the correct diagnosis of diabetes and non-diabetic hyperglycaemia.
• Which tests to use in different circumstances to determine a diagnosis.
• How to avoid making errors in classification of the type of diabetes being diagnosed.
• The appropriate steps to take following diagnosis.

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Type 2 diabetes: a case study, priscilla cunningham nursing student, queen’s university belfast, belfast, northern ireland, helen noble lecturer, health services research, school of nursing and midwifery, queen’s university belfast, belfast, northern ireland.

Increased prevalence of diabetes in the community has been accompanied by an increase in diabetes in hospitalised patients. About a quarter of these patients experience a hypoglycaemic episode during their admission, which is associated with increased risk of mortality and length of stay. This article examines the aetiology, pathophysiology, diagnosis and treatment of type 2 diabetes using a case study approach. The psychosocial implications for the patient are also discussed. The case study is based on a patient with diabetes who was admitted to hospital following a hypoglycaemic episode and cared for during a practice placement. The importance of early diagnosis of diabetes and the adverse effects of delayed diagnosis are discussed.

Nursing Standard . 29, 5, 37-43. doi: 10.7748/ns.29.5.37.e9142

This article has been subject to double blind peer review

Received: 20 May 2014

Accepted: 15 July 2014

Blood glucose - case study - diabetes - glucose testing - hyperglycaemia - hypoglycaemia - insulin resistance - sulfonylureas - type 2 diabetes

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07 October 2014 / Vol 29 issue 5

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Clinical pearls, case study: a woman with type 2 diabetes and severe hypertriglyceridemia sensitive to fat restriction.

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Deborah Thomas-Dobersen; Case Study: A Woman With Type 2 Diabetes and Severe Hypertriglyceridemia Sensitive to Fat Restriction. Clin Diabetes 1 October 2002; 20 (4): 202–203. https://doi.org/10.2337/diaclin.20.4.202

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L.S. is a 52-year-old Caucasian woman who was diagnosed with type 2 diabetes in 1988. She developed hypertriglyceridemia 3 years later and hypertension 9 years later. Other medical problems include obesity and diverticulosis. She presents now for screening to determine eligibility for a clinical research protocol using once-daily insulin.

Physical exam reveals a height of 64 inches, a weight of 181 lb, a body mass index of 31 kg/m 2 , and a waist circumference of 40 inches. Blood pressure, well controlled on 20 mg lisinopril (Prinivil) daily, is 104/70 mmHg.

Laboratory results reveal a fasting lipid panel as follows: total cholesterol 214 mg/dl, triglycerides 940 mg/dl, direct HDL cholesterol 24 mg/dl, an invalid LDL cholesterol unobtainable because of the hypertriglyceridemia, and a free fatty acid of 1.1 mEq/l (normal range 0.1–0.6 mEq/l). Hemoglobin A 1c (A1C) is 9.5%, and fasting blood glucose (FBG) is 304 mg/dl. When called to discuss the finding of severe hypertriglyceridema, the patient commented that she had previously had fasting triglycerides as high as 3,000 mg/dl.

L.S. is currently taking metformin (Glucophage), 1,000 mg twice daily, and glipizide (Glucatrol XL), 10 mg twice daily, to control her blood glucose. She is also on gemfibrizol (Lopid), 600 mg twice daily, for hypertriglyceridemia and estradiol (Estraderm) for menopause (topical estrogen does not induce hypertriglyceridemia).

What nutritional modification would be effective in rapidly lowering serum triglycerides when the patient is at risk of pancreatitis?

What treatment strategies can be employed to lower triglycerides, and how effective are they?

How can nutritional modifications improve insulin resistance?

Type 2 diabetes carries a two- to fourfold excess risk of coronary heart disease. The most common pattern of dyslipidemia in patients with type 2 diabetes is elevated triglycerides and decreased HDL levels. 1 Although coexistent increases in small, dense LDL cholesterol particles—not the triglycerides themselves—may be responsible for the increase in cardiovascular risk, hypertriglyceridemia poses a significant burden on society. 2  

In type 2 diabetes, characterized by insulin resistance and insulin deficiency, the pathophysiology of hypertriglyceridemia is an increased hepatic production of triglycerides as well as a decreased lipoprotein lipase activity leading to slower breakdown of VLDL cholesterol and chylomicrons. 3 The American Diabetes Association (ADA) Clinical Practice Recommendations list serum triglycerides ≥400 mg/dl and an HDL level <45 mg/dl for women as indicative of high risk of coronary heart disease. 1  

By both ADA and National Cholesterol Education Program (NCEP III) guidelines, the first goal for this patient is to lower triglycerides to prevent pancreatitis, which not only can result in hospitalization, but also is potentially lethal. 4 Although L.S. is already on the maximum dose of gemfibrozil, her triglycerides are still inadequately controlled.

With triglycerides in this range, she should be alerted immediately to the fact that any alcohol, even that found in over-the-counter cold remedies can trigger pancreatitis until her serum triglycerides are brought down to a safer range (<500 mg/dl). In addition, a single high-fat meal can also trigger pancreatitis.

A severely restricted fat intake (<10% of daily kcal) can effectively bring down serum triglycerides by 20% per day until triglycerides are <500 mg/dl. A diet in which fat is so severely restricted usually brings about weight loss as well. A loss of 2.5 kg body weight would bring an expected 15–20% decrease in serum triglycerides. In addition, aerobic exercise can help to lower serum triglycerides by 10–15%. 2  

Interventions to further decrease serum triglycerides to <200 mg/dl, increase HDL to 45 mg/dl, and decrease LDL to <100 mg/dl should be attempted to decrease the risk of coronary heart disease.

At the first clinic visit, L.S. was advised of the risk of pancreatitis and advised to forego any alcohol and to adhere to severe fat restriction until she has a fasting serum triglyceride level <400 mg/dl. She and her husband are both from the South, and their traditional Southern fare used quite a bit of salt pork, which deleteriously augmented the saturated as well as total fat in her diet. She had been advised to “watch her weight” when her triglycerides were in the 3,000 mg/dl range, but she had been unable to follow that recommendation.

Between clinic visits, L.S. was given written information about a low-fat (10% of kcal) diet, including lists of foods to restrict and foods to encourage until a more thorough meal plan could be developed based on an assessment of her previous dietary patterns. She was advised that this was a short-term, severe dietary change. She had already instituted an exercise program, walking for 1 hour, five times a week regularly.

Two weeks later, when L.S. returned to clinic after following the suggested fat restriction, her lab results showed the following lipid profile: serum total cholesterol 193 mg/dl, serum triglycerides 355 mg/dl, direct HDL cholesterol 32 mg/dl, and LDL cholesterol 90 mg/dl. Her A1C had dropped to 8.8% with no change in therapy for her diabetes, and her FBG was 158 mg/dl. Her fasting free fatty acid level was 0.7 mEq/l. Her weight had dropped by 3 lb.

At this visit, medical nutrition therapy (MNT) was initiated, and the patient was put on 10 units of 75/25 insulin before dinner.

Six weeks later, her A1C had dropped further, to 7%, her FBG was 110 mg/dl, and her weight was down another 2 lb. Her lipid profile was as follows: total cholesterol 181 mg/dl, triglycerides 299 mg/dl, direct HDL cholesterol 32 mg/dl, and LDL cholesterol 89 mg/dl. Her fasting free fatty acid level was now 0.6 mEq/l, the upper level of normal. Meal plan records showed that she was consuming ∼1,500 kcal/day and getting ∼25% of daily kcal from fat.

Commonly, controlling hyperglycemia leads to a decrease in triglycerides. 1 However, in this patient, the clearing of serum triglycerides, the restricted saturated fat, and the weight loss had a substantial impact on improving glucose tolerance without adding further diabetes oral agents. Studies have shown that dietary fat, primarily saturated fat, has adverse effects on insulin sensitivity. 5 Restricting fat intake, especially saturated fat, resulted in a better metabolic profile in regard to both glucose tolerance and fasting serum triglycerides.

Lifestyle changes had been recommended previously; why was L.S. successful this time when she hadn’t been before? The patient offered the following comments when asked this question.

“I was handed written information, but concern about the numbers (hypertriglyceridemia) was never conveyed.”

“They tell you what you need to do, but not how or why to do it.”

“No one sat down and talked with me. I never received individualized attention.”

“If my triglycerides were potentially harmful, why did they not see me sooner than 3 months? Three months was the usual time between visits and again they conveyed no concern.”

In previous attempts to encourage this patient make lifestyle changes, the compliance approach was used, but the benefits of self-care, the costs of not complying, the susceptibility to pancreatitis and cardiovascular disease, and the severity of such elevated triglycerides were not conveyed. A referral to an educator, time spent in assessing eating patterns and teaching alternatives, and more frequent visits or follow-up serve to convey the importance of recommended lifestyle changes. MNT coupled with an empowerment approach through which patients are the primary decision makers is important.

Although lifestyle changes are always recommended as first-line therapy, the approach to helping patients achieve these lifestyle changes in busy office practices is too often insufficient. A new Medicare benefit effective January 2002 allows patients with diabetes access to insurance coverage for MNT. Evidence-based research shows that MNT provided by a registered dietitian experienced in the management of diabetes is clinically effective. 6  

Reducing dietary fat improves body weight, which in turn improves glucose tolerance and hypertriglyceridemia. 7 – 9  

There is evidence that saturated fat may elevate plasma glucose by way of increasing insulin resistance.

MNT for hypertriglyceridemia may be divided into three parts:

  1. When fasting triglycerides are ≥1,000 mg/dl, restrict dietary fat to 10% of kcal until fasting triglycerides fall to <500 mg/dl.

  2. For fasting triglycerides between 1,000 and 500 mg/dl, a ) reduce saturated fat to <7% of energy and dietary cholesterol to 200 mg/day; b ) increase viscous (soluble) fiber to 10–25 mg/day; c ) encourage modest weight loss (5–7% of body weight); and d ) increase physical activity. 10 Monounsaturated fats or carbohydrates can be used to substitute for the decrease in saturated fats.

  3. For fasting triglycerides <500 mg/dl, encourage weight loss and a decrease in simple sugars in addition to the above reduction in saturated fat.

Deborah Thomas-Dobersen, RD, MS, CDE, is a professional research assistant and certified diabetes educator in the Endocrinology Department of the University of Colorado Health Sciences Center in Aurora.

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Elizabeth Nash, Yesenia Nunez and Casey Salinas

Molly is a 22 y.o. female performing arts student at CSUCI with an emphasis in theater. At 16 y.o., she was diagnosed with type 1 DM. Her pharmacological regimen consist 2 different types of insulin, which include glargine (long acting, basal) and humalog (rapid acting, meal coverage). Molly is an aspiring actress and struggles with her body image. She noticed weight gain ever since she started taking insulin. She discovered that by skipping her insulin she is able to “lose weight” and is able to maintain her image of an “industry standard body.” Molly’s roommate found her in a decompensated state in their dorm and called 911.

Upon field assessment, Molly was confused and diaphoretic. She was oriented X 2 (person, place). Pupils were equal, round, reactive to light and accommodated. She was tachycardic and has +1 peripheral pulses. Molly had Kussmaul respirations with a RR of 34 b/min with an abdominal pain level of 7/10. Her blood sugar was 850 mg/dL. Field Vitals: BP: bolus started, and NC at 2L/min was placed.

• What are your primary concerns with Molly?
• Why do you expect type I diabetic mellitus patients such as Molly engage in behaviors consistent with diabulimia?
• As the case manager, what resources would you recommend prior to discharge?

Nursing Case Studies by and for Student Nurses Copyright © by jaimehannans is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License , except where otherwise noted.

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Use of case studies to teach diabetes and other chronic illnesses to nursing students

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• DOI: 10.3928/01484834-20060601-07

Nursing students frequently have difficulty understanding diabetes mellitus and other chronic illnesses. Using the active learning technique of the case study method enables students to understand the difficulty in taking care of clients with chronic illnesses. Three forms of the case study method are shared. The students are enlightened about clients' difficulty in taking care of themselves after the diagnosis of a chronic illness. The case study method is leveled and used to develop critical thinking by focusing on the client's needs and collaborating to solve problems. This enables students to develop a clearer understanding of the disease, how it affects clients and their needs, and responses to studies of the disease.

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The questions can be used by faculty to prepare students to understand the new format of Next Generation (NextGen) test items that are like those that will be used by the National Council of State Boards of Nursing (NCSBN) licensing exam beginning in April 2023 to test students’ ability to make clinical judgments.

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Introducing our Diabetes Case Study, a dynamic educational resource designed to immerse students in real-world patient care scenarios. Tailored for healthcare students, this case study presents a newly diagnosed pediatric patient, offering a comprehensive exploration of diabetes management from diagnosis to treatment.

This engaging resource delves into diabetes symptoms, lab interpretation, and patient teaching strategies, providing students with a holistic understanding of the disease process. By navigating through the case report, students develop critical thinking skills and clinical reasoning, preparing them for the challenges of healthcare practice.

Key highlights of the Diabetes Case Study include investigation of different types of insulin, dosage calculation methods for mealtime insulin using carbohydrate ratios and correction scales. Sstudents learn to personalize insulin regimens based on individual patient needs, honing their dosage calculation abilities. Additionally, students will practice strategies for communicating effectively with pediatric patients.

Ideal for both individual study and group work, this case study fosters collaborative learning environments where students can exchange ideas, discuss best practices, and solve clinical dilemmas together. Whether used in the classroom or for self-directed learning, our Diabetes Case Study equips students with the knowledge and skills necessary to provide optimal care for patients with diabetes.

Invest in your education and prepare for the complexities of healthcare practice with our Diabetes Case Study – your gateway to mastering diabetes management in a clinical setting.

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Diabetic Ketoacidosis (DKA) Case Study (45 min)

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Mr. Logan is a 32-year-old male with a history of DM Type I. He presented to the Emergency Department (ED) after being found by his family with decreased LOC, rapid heavy breathing, and fruity breath. His family reports flu-like symptoms for the last few days.

Before even gathering further information - what do you think is going on? Why?

Diabetic Ketoacidosis – he is a Type I Diabetic with heavy breathing (Kussmaul Respirations) and fruity breath. These are classic signs. It’s important to recognize them and immediately begin anticipating the patient’s needs.

What diagnostic or lab tests would you expect the provider to order?

• Complete metabolic panel to check serum glucose, anion gap, potassium, etc.
• Arterial Blood Gas to assess for acidosis
• Urinalysis to look for ketones

The nurse draws a Complete Metabolic Panel and notifies the Respiratory Therapist to obtain an Arterial Blood Gas. Upon further assessment, the patient is oriented x 2 and drowsy. He is breathing heavily. Lungs are clear to auscultation, S1/S2 present, bowel sounds active, pulses present and palpable x 4 extremities. A POC glucose reads >450 (meter max).

Vital signs are as follows: HR 87 RR 32 BP 123/77 SpO 2 96%

Mr. Logan’s labs result and show the following: Glucose 804 mg/dL K 6.1 mEq/L BUN 39 mg/dL pH 7.12 Cr 1.9  mg/dL pCO 2 30 Anion Gap 29 mEq/L HCO 3 – 17 Urine = Positive for Ketones

Using these lab results, explain what is going on physiologically with Mr. Logan.

• His glucose is extremely high and he is positive for ketones, which says that his body is having to break down fatty acids to make energy
• His anion gap is high, meaning there are other “ions” in the system besides the electrolytes – in this case, the extra acids are creating this ‘gap’
• He is in metabolic acidosis because of the ketoacids – this is what’s causing the Kussmaul respirations – his body is trying to breathe off CO2 to bring his pH up
• His potassium is high because the body will kick potassium out of the cells to compensate for an acidotic state. This way instead of having H+ (acids) in the blood stream, we have K+ – this protects many tissues, but puts our heart at risk
• His BUN/Cr are elevated because of the dehydration caused by osmotic diuresis (caused by hyperglycemia and hyperosmolarity)

What is the #1 priority for Mr. Logan at this time?

• The #1 priority for DKA is to get the blood sugar down and get insulin into the system. Getting insulin into the system allows the gluconeogenesis to STOP (so that the body will STOP making ketoacids and start using the glucose it has).
• The #2 priority is fluid replacement due to severe dehydration from osmotic diuresis

The provider writes an order for an Insulin Lispro infusion IV, titrating to decrease blood glucose per protocol, 1L NS bolus NOW, and a continuous infusion of Normal Saline IV at 250 mL/hr, and to change the fluids to D5 ½ NS at 125 mL/hr once the blood glucose level falls below 250 mg/dL.

What is the first action you should take after receiving these orders?

Remind the provider that the only insulin that can be given IV is Regular Insulin and request that he change the order. Call the Pharmacist if you have to

• **Note – most facilities have a computerized ordering that prevents something like this from happening, but it’s important that you know this!!

The provider adjusts the order to Regular Insulin IV infusion.  Orders are also written for hourly POC glucose checks and a q2h BMP.

Why is it important to check a BMP frequently? What are we monitoring for?

• Frequent BMP’s are important to confirm the blood glucose when the POC meter is just reading MAX.  
• It’s also important to monitor the Anion Gap to see when it “closes” – indicating resolution of the acidosis
• We are also monitoring potassium levels. They will start elevated, but insulin drives potassium into the cells – causing it to decrease rapidly.

After 4 hours and another 1L bolus of NS, Mr. Logan’s blood glucose level has dropped to 174 mg/dL, but his anion gap is still 19. The nurse changes his fluids to D5 ½ NS per the order and continues the insulin infusion. The most recent BMP showed a K of 3.7, down from 6.1, so the provider orders to give 40 mEq of KCl PO.

Why is the insulin continued even after the blood glucose decreases?

• The goal is to stop gluconeogenesis and reverse the acidosis. The glucose may fall rapidly while there are still ketoacids being made.
• By giving D5 ½ NS infusion with the insulin, we can continue to bring down the acidosis process while maintaining safe blood sugars.

After another 4 hours, Mr. Logan’s anion gap is now 12, a repeat ABG shows a pH of 7.36 with normal CO 2 and HCO 3 – levels.  The nurse begins to transition Mr. Logan off of the IV infusion to SubQ insulin per protocol.  He is feeling much better and says he’s embarrassed that he had to be brought to the hospital.  

What education can you provide Mr. Logan to help him understand why this happened and how to prevent it from recurring in the future?

• When you are ill, you should check your blood sugar more often as sometimes the body’s healing processes and stress response can make your sugar go higher than normal
• Notify your provider if you’re ill, they may recommend increasing your long-acting insulin
• Notify your provider or go to the ED at the FIRST indication of DKA – fruity breath, heavy breathing, feeling dry and hot, excessive urination, blurry vision, or a blood glucose over 400 mg/dL or over your meter MAX.  
• If you have an insulin pump, make sure it is working appropriately – if not, notify your provider or turn the pump OFF and switch to SubQ insulin until the pump can be fixed
• **Note – if a patient comes in with an insulin pump, it should always be turned OFF – we will manage their sugars with SubQ insulin and don’t want them to receive a double dose.

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Nursing Case Studies

This nursing case study course is designed to help nursing students build critical thinking.  Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process.  To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy  to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs.  If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding.  In the end, that is what nursing case studies are all about – growing in your clinical judgement.

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New research sheds light on the behavioral and psychological symptoms of Alzheimer’s disease and related dementias

Written by: Laura Frnka-Davis | Updated: August 15, 2024

A study offering insights into understanding and managing the behavioral and psychological symptoms of Alzheimer’s disease and related dementias led by a team of UTHealth Houston researchers has been published in Alzheimer’s & Dementia , the journal of the Alzheimer’s Association.

Carolyn Pickering, PhD, RN, professor and Isla Carrol Turner Chair in Gerontological Nursing at Cizik School of Nursing at UTHealth Houston and a noted expert in dementia family caregiving, led the research applying an innovative framework to identify patterns of behavioral and psychological symptoms of dementia. Her research distinguishes between general profiles of symptoms common among different people, known as subsyndromes, and the way symptoms group together based on daily variations in symptoms experienced by individuals, referred to as symptom clusters.

“Behavioral and psychological symptoms of dementia can vary within the same person due to factors like the time of day, noise levels, and even hydration status,” said Pickering, first and corresponding author on the study, and head of the Pickering Caregiver Lab team, a research hub to advance the care of people with dementia. “Our study is significant because it offers a new way of thinking about how to manage symptoms for persons living with dementia that may be more effective than current approaches that tend to lump all symptoms together as one experience.”

The study followed 68 family members who live with and care for family members living with dementia. Caregivers reported daily on their loved ones’ 23 different symptoms related to dementia, including eating difficulties, uncooperativeness, delusions, depression, anxiety, apathy, and wandering, producing a total of 443 daily reports over the course of eight days. To analyze the data, Pickering and her team used a novel statistical method that considered the variation within each person and between different people.

Researchers noted a high occurrence of possible delirium in home care settings, usually associated with hospitals. The finding highlights the need for better awareness and education on how caregivers can manage delirium at home.

“By understanding and addressing both subsyndromes and symptom clusters, we can create new and targeted ways to help health care professionals and caregivers manage dementia symptoms more effectively,” said Pickering. “This comprehensive approach will improve the quality of care and support for individuals with dementia and their families.”

Funded by the Alzheimer’s Association, this research makes significant strides in managing behavioral and psychological symptoms of dementia.

Additional UTHealth Houston authors include Vicki Winstead, PhD, MA, senior program manager at the Pickering Caregiver Lab; Mustafa Yildiz, PhD, assistant professor at Cizik School of Nursing; and Andrew Pickering, PhD, associate professor at McGovern Medical School at UTHealth Houston. Other authors are Danny Wang and Maria Yefimova, lead nurse scientist at University of California San Francisco. 

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Investigation of nursing students' addiction to digital game play and associated factors

• Hasan Sağlam   ORCID: orcid.org/0000-0002-8307-6996 1 &
• Nuray Turan   ORCID: orcid.org/0000-0002-8362-3427 2  

BMC Nursing volume  23 , Article number:  563 ( 2024 ) Cite this article

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Metrics details

It was conducted to investigate digital gaming addiction among nursing students and the associated factors of such addiction.

The descriptive and relationship-seeking study's universe included 1665 nursing students in three universities' nursing faculties and departments. The sample size was determined to be 774 based on a power analysis with a type I error rate of 0.05, a power of the test of 0.80 (α = 0.05, 1-β = 0.80), and an effect size of d = 0.10. Student Information Form, The Digital Game Addiction Scale (DGAS-7), and the Digital Game Playing Motivation Scale (DGPMS) were used to collect student information. Data analysis was performed using the Mann–Whitney U test, Kruskal–Wallis H test, Spearman correlation, and Binary Logistic Regression Model.

It was found that 83.7% of the students were female, and the mean age and BMI were 20.03 ± 1.72 years and 21.98 ± 2.90 kg/m 2 , respectively. A statistically significant positive correlation was found between the students' Digital Game Addiction Scale and Digital Game Playing Motivation Scale Achievement and Energizing ( r  = 0.717), Curiosity and Social Acceptance ( r  = 0.612), and Uncertainty in Game Desire ( r  = -0.110) sub-dimensions mean scores ( p  < 0.001).

Conclusions

The relationship between nursing students' digital game addiction, game playing motivation, and several individual characteristics affecting digital games was found. The study's results call for further research to focus on developing and testing interventions that could effectively reduce gaming addiction while enhancing positive aspects of digital engagement among nursing students.

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Introduction

Due to technological advancements, urbanization, and decreased physical play areas, the current generation increasingly turns to indoor activities and digital gaming, utilizing computers, game consoles, and online games. The phenomenon of digital gaming addiction has evolved significantly across different generations. The Silent Generation and Baby Boomers experienced the early days of gaming with arcade games and rudimentary home consoles, where addiction was rare due to limited access. Gen X witnessed the advent of more advanced gaming systems like Atari and Nintendo, leading to increased engagement, though gaming addiction was still not widely recognized. Millennials grew up with the rapid expansion of digital technology and the internet, facing the first wave of widespread gaming addiction as games became more immersive and socially connected. Gen Z has been immersed in a digital world from birth, with higher instances of gaming addiction due to the rise of eSports, streaming platforms, and mobile gaming. Gen Alpha is growing up in an era of ubiquitous digital technology, with gaming integrated into early childhood experiences, making the long-term effects of early exposure to digital gaming and potential addiction an ongoing concern. Over time, digital gaming addiction has progressed from a rare phenomenon to a widespread issue, particularly affecting Millennials and Gen Z, with implications for future generations like Gen Alpha [ 1 ]. This shift towards virtual environments is prevalent and expanding among children and adolescents, with a significant daily increase in digital game players. The popularity of these games continues to grow even among younger children [ 1 , 2 , 3 , 4 ]. The uncontrolled urge to engage in digital gaming can lead to significant changes in social life, emotions, and thoughts, potentially culminating in gaming addiction [ 5 , 6 , 7 ]. International studies have shown that the incidence of gaming addiction varies between 2 and 15% [ 3 , 8 ], and according to the American Medical Association, 90% of adolescents engage in digital gaming, with 15% demonstrating addictive behaviors [ 9 ].

Digital games offer a virtual realm where users can fulfill their fantasies, creating a world that doesn’t exist in reality [ 3 , 6 , 10 ]. Within university settings, where interpersonal interactions and communication are emphasized, young adults frequently engage in digital gaming to connect with friends [ 8 , 10 , 11 ]. Research by Shuvo and Biswas has indicated a significant association between the time spent on screen-based devices and playing digital games with overweight and obesity among university students [ 12 ]. Moreover, findings by Polat and Topal suggest that digital game addiction is significantly predicted by factors such as gender, academic achievement, and hours spent gaming on computers and smartphones each week rather than by body mass index or types of players [ 13 ].

The research on digital gaming addiction among nursing students is essential due to its impact on the cognitive and emotional skills critical for patient care, such as attention, decision-making, and stress management. This focus is crucial in nursing education to prepare students for the demanding healthcare environment. These consequences are not exclusive to nursing students; however, they are particularly significant for this group due to their direct implications on patient care and safety. While other university students might experience reduced academic performance and social interaction from gaming addiction, these issues do not typically present immediate life-or-death consequences. In contrast, in nursing, digital addiction directly impacts public health and safety. This study underscores the need for proactive measures in nursing education to equip students with the skills to tackle digital addiction effectively, enhancing patient safety and overall care quality. This approach benefits the nursing professionals and the broader healthcare system, establishing the study's relevance and necessity in training nurses to handle complex health challenges, including addictions, in their careers. The central research questions were as follows:

What are the levels of digital game addiction and digital game playing motivation among nursing students?

What factors affect nursing students' digital game addiction and digital game playing motivation?

Materials and methods

Study design and participants.

The study was designed to be descriptive and correlational, aiming to investigate the addiction of nursing students to digital gaming and associated factors. The research was conducted on a population of 1665 nursing students studying at nursing faculties and departments at two state universities and one foundation university in Istanbul during the 2020–2021 academic year. Using the G*Power 3.0.10 program, the sample size was determined to be 774 based on a power analysis with a type I error rate of 0.05, a power of the test of 0.80 (α = 0.05, 1-β = 0.80), and an effect size of d = 0.10 [ 9 ]. In this study, the sample comprised 774 nursing students. The criteria for sample selection were being a nursing student who was enrolled and actively attending classes at the time of the study, having no communication problems, playing computer or video games, and volunteering to participate in the study.

Measurements

The data were collected using the Nursing student information form, the Digital Game Addiction Scale (DGAS-7), and the Digital Game Playing Motivation Scale (DGPMS).

Nursing student information form

The questionnaire developed by the researchers on the relevant literature was based on factors such as the student's sex, age, age groups, marital status, class, body mass index (BMI), BMI classification, class, and digital gaming tool (smartphone, tablets, consoles) [ 3 , 5 , 8 , 14 ].

The digital game addiction scale (DGAS-7)

Yalçın Irmak and Erdoğan [ 5 ] adapted the scale Lemmens et al. [ 15 ] created to identify problematic digital game playing behaviors in Turkish. The DGAS-7 is the short form of the DGAS-21 and consists of 7 subdimensions and 21 items. The DGAS-7 consists of 7 items in total. The scale consists of five-point Likert-type questions, ranging from 1 to 5, with overall scores between 7 and 35. Two formats, monothetic and polythetic, were preferred to determine whether an adolescent was addicted to gaming according to the DOBÖ. In the monothetic format, if the individual scores 3 (sometimes) and above 3 on all 7 items in the scale, he/she is considered risky, and according to another format, polythetic, if he/she scores 3 (sometimes) and above 3 on at least 4 of all items, he/she is considered a high-risk game addict [ 5 ]. An increase in score on the scale means that it reflects more severe levels of addiction to digital games and suggests worsening conditions in terms of gaming behavior. Higher scores on this scale indicate a higher likelihood of digital game addiction [ 5 ]. The Cronbach's alpha coefficient of the original scale was 0.920, while in the Turkish version and this study, the values were 0.730 and 0.823, respectively.

The digital game playing motivation scale (DGPMS)

The scale devised by Tekkurşun Demir and Hazar [ 16 ] to ascertain the motives for playing digital games consists of 19 items and 3 subdimensions. It comprises 3 subdimensions: Success and revival, curiosity and social acceptance, and uncertainty in willingness to play. On the five-point Likert-type scale, in the scoring of this scale, this part, including the 1st to 14th items, is scored directly, while the part between the 15th and 19th items is scored reversely. The lowest score that can be obtained from the DGPMS is 19, and the highest score is 95. The higher the score obtained from this scale, the greater an individual's motivation to play digital games, indicating that participants with high scores exhibit positive motivation. The Cronbach alpha coefficients are 0.96 for the Digital Gaming Play Motivation Scale, 0.70 for achievement and revitalization, 0.87 for curiosity and social acceptance, and 0.72 for uncertainty in-game requests [ 16 ]. In this study, Cronbach's alpha coefficient was 0.825 for achievement and revival, 0.926 for curiosity and social acceptance, and 0.909 for uncertainty in willingness to play.

Data collection

After providing institutional approval and ethical clearance, study data was collected using Google Forms. The Student Affairs departments at the participating nursing faculties were initially contacted via their institutional email addresses to facilitate the study distribution. Once the necessary permissions were obtained, the data collection forms link was provided to these offices.

Subsequently, the Student affairs offices emailed the data collection forms to nursing students in all academic years (first through fourth) using the student's official university email addresses. Throughout this process, care was taken to ensure that no identifying information such as names, student numbers, or any other personal identifiers was collected, maintaining the confidentiality and anonymity of all participants. The process was designed to emphasize the voluntary nature of participation, allowing students to opt-out at any time without repercussions.

Data collection forms were delivered online through three universities' nursing faculties and departments. The study details were presented on the first page of each form. Before commencing, students were required to click the “I approve” button if they agreed to participate. Completing the data collection forms took approximately 15 min.

Ethical approval

The study was approved by the Ethics Committee of Istanbul University-Cerrahpaşa, Social Sciences, and Humanities Research Ethics Committee (Date: 13.10.2020 Number: 70800) and conducted in accordance with the ethical standards laid down by the Declaration of Helsinki (1964) and all subsequent revisions.

Data analysis

The statistical analyses were performed using SPSS (IBM SPSS Statistics 24) software. Tables containing frequency distributions and descriptive statistics were used to interpret and explain the data obtained in the study. As a result of the Shapiro–Wilk test applied, p was found to be < 0.05, and it was determined that the data did not comply with normal distribution. Non-parametric methods were used for measurement values ​​that did not comply with normal distribution. The Mann‒Whitney U test was used to analyze two independent groups, while the Kruskal‒Wallis H test was used for three or more independent groups. When a significant difference was identified for three or more independent groups, the Bonferroni correction was applied to examine the variable values by comparing them in pairs. The Spearman correlation coefficient was utilized to investigate the relationship between the abnormally distributed data. We used a binary logistic regression model to determine the factors influencing the risk of digital game addiction. We assessed the outcomes at a 95% confidence interval using a significance level of p  < 0.05.

Characteristics of nursing students

Examining the students' characteristics, 83.7% ( n  = 648) were female, with a mean age of 20.03 ± 1.72 years. Additionally, 32.3% were 21 years or older, 99.2% ( n  = 768) were single, and their average BMI was 21.98 ± 2.90 kg/m 2 . Furthermore, 76.4% ( n  = 591) of the students were classified as having an average weight according to their BMI. A total of 34.1% ( n  = 264) of the nursing students were 1 year of study; all ( n  = 774) lived at home, and 94.8% ( n  = 734) preferred smartphones as a tool (Table  1 ).

Levels of digital game addiction and digital game playing motivation among nursing students

The nursing students' mean total score on DGAS-7 was 12.65 ± 4.29 (min.-max: 7.0–35.0), and the mean total scores on the DGPMS subdimensions were 12.60 ± 4.51 (min.-max: 5.0–25.0) in achievement and revival, 23.63 ± 9.34 (min.-max: 9.0–45.0), and 15.25 ± 6.08 (min.-max: 5.0–25.0) uncertainty in-game requests (Table  2 ).

The DGAS-7 has a possible score range from 7 to 35, with higher scores indicating greater levels of game addiction. A mean score of 12.65 suggests a relatively low level of game addiction among nursing students.

Table 3 shows a positive and significant relationship between the DGAS-7 score and the subdimensions of the DGPMS score and between the scores and the mean scores for success and revival ( r  = 717; p  < 0.001), curiosity, and social acceptance ( r  = 0.612; p  < 0.05). There was no correlation between the DGAS-7 score and the uncertainty in the willingness to play ( r  = -0.110; p  = 0.002) of the DGPMS ( p  > 0.05).

Associated factors of nursing students' digital game addiction and digital game playing motivation

As shown in Table  4 , the mean DGAS-7 scores of the male nursing students were significantly greater than those of the female nurses (Z = -7.188; p  < 0.001).

The mean DGAS-7 score was significantly greater for students aged 21 years and older (χ2 = 15.374; p  = 0.002). At the same time, it was determined that the mean scores of the DGPMS success and revival (Z = -5.785; p  < 0.001), curiosity, and social acceptance (Z = -5.852; p  < 0.001) sub-dimensions of male students were statistically significantly higher than female students ( p  < 0.05). Students aged 21 years and over had statistically significantly higher mean scores in the DGPMS success and revival (χ2 = 20.663; p  < 0.001), curiosity, and social acceptance (χ2 = 17.183; p  = 0.001) sub-dimensions compared to other age groups. The mean score of 20-year-old students in the DGPMS uncertainty in willingness to play (χ2 = 9.778; p  = 0.021) subscale was statistically significant compared to different age groups (Table  4 ).

Concerning marital status, the mean DGAS-7 score was significantly greater for single students (Z = -2.325; p  = 0.020). The overweight students' mean DGAS-7 scores (χ2 = 10.671; p  = 0.014) according to their BMI were greater than those of the other groups (Table  4 ).

Considering BMI, it was determined that the mean scores of the DGPMS success and revival (χ2 = 11.474; p  = 0.009) sub-dimension scores of overweight students were significantly higher than the others ( p  < 0.05) (Table  4 ).

According to the class variable, the mean DGAS-7 scores of students in years 2, 3, and 4 were significantly greater than those in 1 year of study (χ2 = 18.764; p  < 0.001) (Table  4 ). Regarding the game tool, the mean DGAS-7 score of the nursing students who played with a tablet was significantly greater than that of those who played with a smartphone (Z = -2.277; p  = 0.023). According to the digital gaming tool, the mean scores of the DGPMS success and revival (Z = -2.240; p  = 0.025), curiosity, and social acceptance (Z = -2.913; p  = 0.004) sub-dimension scores of the students who preferred to play digital games with tablets were statistically significantly higher than those who played with smartphones ( p  < 0.05) (Table  4 ).

According to Table  5 , according to the logistic regression (LR) analysis performed by considering the risk status of nursing students' Digital Game Addiction Scale, it was determined that the Success and Revival subscale of the Digital Game Playing Motivation Scale was a significant variable on the risk of digital game addiction ( p  < 0.05). When the Success and Revival Score increases by 1 unit, the risk of digital game addiction increases by 47.2% (OR = 1.472).

Students may engage with digital games for various reasons during their university education, potentially leading to digital game addiction if not properly managed [ 16 , 17 ]. This study found that digital game addiction among nursing students, as measured by DGAS-7, was generally low. This observation aligns with previous research by Aktan [ 18 ] and Aktaş with Bostancı-Daştan [ 3 ], which also noted low levels of game addiction among nursing students. Despite the challenges posed by the pandemic, nursing students appear to be aware of potential digital gaming issues and manage their gaming habits accordingly.

Regarding motivation for playing digital games, DGPMS revealed that curiosity and social acceptance were significant factors. These external motivations drive gaming behavior, which include the desire for rewards such as trophies and status and the sensory appeal of game sounds and effects [ 19 ]. Further studies have confirmed that curiosity and social acceptance are predominant, followed by motives like uncertainty, success, and survival in gaming scenarios [ 20 ]. This indicates that external factors are strong determinants of gaming behavior among nursing students, primarily motivated by curiosity, as is common among their peers in different fields.

The subdimension of uncertainty in gaming desire, which ranks second for motivational factors in digital gaming, suggests that students engage in gaming without fully considering the consequences or causes of their gaming habits [ 21 ]. This aspect is crucial as it contrasts with the critical thinking and evidence-based practices emphasized in nursing education, grounded in real-world experiences.

Interestingly, the study also highlights that intrinsic motivations such as achievement and revitalization, which include elements like ambition and happiness, are less influential among nursing students [ 22 , 23 ]. This finding, corroborated by Güler and Çakır [ 21 ], suggests a lesser inclination towards gaming driven by these intrinsic factors, challenging some prior studies [ 1 , 2 ].

Correlations were observed between various motivational subdimensions—achievement, revival, curiosity, and social acceptance—and digital game addiction [ 24 , 25 ]. These correlations suggest that while motivations can vary, they significantly influence the likelihood of addiction, particularly through social motivations [ 7 ].

Examining demographic factors, we found that male nursing students scored higher on the DGAS-7 than their female counterparts, potentially due to cultural and social dynamics that encourage men more towards gaming [ 3 , 10 , 11 , 25 ]. The influence of gender on game addiction is also seen in different responses to the motivational factors within the DGPMS, where success, revival, curiosity, and social acceptance scores were notably higher among males [ 20 , 21 ].

Age also plays a critical role; older students (21 years and above) reported higher addiction scores, possibly exacerbated by the remote learning conditions imposed during the pandemic [ 6 , 25 ]. This was a deviation from the trends observed in younger age groups, where the pandemic seemed to reduce the interactive aspects of their education, leading to increased gaming.

Marital status and physical health also influenced gaming behavior. Single students and those classified as overweight according to BMI had higher scores on the DGAS-7 [ 26 , 27 ]. This could be attributed to more free time and less engagement in physical activities, respectively.

Lastly, the type of device used for gaming was a significant factor, with students using tablets showing higher addiction scores than those using smartphones [ 4 , 28 ]. The ease of use and the immersive experience provided by tablets might contribute to higher levels of engagement and, consequently, higher motivation and addiction scores.

This analysis demonstrates that digital game addiction and motivation among nursing students are influenced by a complex interplay of demographic, psychological, and environmental factors. Understanding these factors can help in developing targeted interventions to manage potential addiction issues effectively [ 29 ].

Limitations

This study had some limitations. A self-report scale was used to gather information about all the variables that might have the potential for bias. Another limitation was that causality could be explained to a limited extent due to the descriptive and correlational design of the study. The study's non-experimental design was limited to nursing students from three specific universities: two state universities and one foundation university. Consequently, the findings are applicable only to these institutions.

This study investigated the levels of digital game addiction and digital game playing motivation among nursing students and the factors influencing these aspects. The findings indicate that digital game addiction is generally low among nursing students, yet certain factors such as gender, age, BMI, and the type of device used for gaming (particularly tablets) significantly affect both addiction levels and motivational subdimensions.

Male students, those aged 21 and older, overweight students, and those who prefer tablets for gaming are more likely to have higher digital game addiction scores. These demographic and device preference factors also enhance motivational aspects related to digital gaming, particularly in Success and Revival, Curiosity, and Social Acceptance. While overall addiction levels are low, they are influenced by specific demographic and behavioral factors, which are crucial for developing interventions aimed at reducing game addiction risks and promoting healthier gaming habits among nursing students.

This study shows that evaluating nursing students in terms of digital addictions is critical in preventing future health problems. In line with these results, it can be suggested that digital games can be transferred to the nursing curriculum to be used in cognitive and psychomotor areas and that more comprehensive studies on the effects and management of these games on individuals should be suggested.

Availability of data and materials

The data sets used and/or analyzed during the current study are available from the corresponding author at reasonable request.

Demirel HG, Cicioğlu HI, Demir TG. Research on the digital game playing motivation levels of high school students. J Phys Educ Sport Sci. 2019;21(3):128–37.

Google Scholar  

Tekkurşun-Demir G, Cicioğlu HC. The relationship between motivation for physical activity participation and motivation for digital gaming. Spormetre  J Phys Educ Sport Sci. 2019;17(3):23–34.

Aktaş B, Bostancı-Daştan N. Game addiction levels of university students in Covid-19 pandemic and the effect of pandemic on digital gaming status. J Depend. 2021;22(2):129–38.

Öztekin A, Kavan N, Dündar M, Meriç I. Investigation of university students’ digital game addiction during the coronavirus outbreak process. Asya Stud Acad Soc Stud. 2021;5(18):109–19.

Article   Google Scholar  

Yalçın-Irmak A, Erdoğan S. Validity and reliability of the Turkish version of the Digital Game Addiction Scale. Anatolian J Psychiatry. 2015;16(1):10–8.

Lin CY, Imani V, Broström A, Årestedt K, Pakpour AH, Griffiths MD. Evaluating the psychometric properties of the 7-item Persian Game Addiction Scale for Iranian adolescents. Front Psychol. 2019;10:149.

Article   PubMed   PubMed Central   Google Scholar  

Nergiz H, Nergiz SF. A review of national postgraduate theses investigating digital game addiction in children, adolescents, or young people. J Youth Stud. 2021;9(23):53–70.

Turan N, Durgun H, Kaya H, Aştı TA, Yılmaz Y, Gündüz G, Kuvan D, Ertaş G. Relationship between nursing students’ levels of internet addiction, loneliness, and life satisfaction. Perspect Psychiatr Care. 2020;56(3):598–604.

PubMed   Google Scholar  

Yalçın-Irmak A, Erdoğan S. Digital game addiction among adolescents and younger adults: a current overview. Turk J Psychiatry. 2016;27(2):128–37.

Kesici A. The effect of conscientiousness and gender on digital game addiction in high school students. Journal of Education and Future Year. 2020;18:43–53.

Tekkurşun-Demir G, İlhan LE, Esentürk O, Kan A. Motivation Scale for Sports Participation of People with Disabilities (MSSPPD): A study of validity and reliability. Spormetre J Phys Educ Sport Sci. 2018;16(1):91–102, 095–106.

Polat A, Topal M. Relationship between digital game addiction with body mass index, academic achievement, player types, gaming time: A cross-sectional study. J Educ Technol Online Learn. 2022;5(4):901–15.

Shuvo SD, Biswas BK. The degree of association between overweight and obesity with the use of electronic media among Bangladeshi adolescents. PLoS One . 2023;18(1):e0280544.

Savci M, Ercengiz M, Yildiz B, Griffiths MD, Aysan F. Can risky behaviors, gaming addiction, and family sense of coherence accurately classify gender among university students? Curr Psychol. 2021;41:7522–31.

Lemmens JS, Valkenburg PM, Peter J. Development and validation of Game Addiction Scale for Adolescents. Media Psychol. 2009;12(1):77–95.

Tekkurşun-Demir G, Hazar Z. Digital Game Playing Motivation Scale: Validity and reliability study. Niğde Univ J Phys Educ Sports Sci. 2018;12(2):128–39.

Ryu HJ, Kim H. The relationship between self-control and Internet game addiction proneness in college students: dual mediating effects of perceived stress and coping strategy. Korean J Clin Psychol. 2018;37(2):156–65.

Aktan E. Assessment of social media addiction levels of university students by numerous variables. J Erciyes Commun. 2018;5(4):405–21.

Güngören ÖC. The effects of adaptive educational web environment on students’ academic achievement and motivation. Kastamonu Educ J. 2019;27(3):1311–26.

Özcan K, Sengir S. Examining the digital game-playing motivations of students studying graphic design in terms of various variables. Ondokuz Mayis Univ J Educ Facult. 2020;39(3):155–69.

Güler MS, Çakir E. Analysis of the relationship between digital game-playing motivation and physical activity. Afr Educ Res J. 2020;8:9–16.

Bozkurt Mutlu T, Tamer K. Relationship between digital game motivation and body mass index. Gaziantep Univ J Sport Sci. 2020;5(2):105–20.

Altay A, Koç H. Investigation of the relationship between physical activity participation motivation and digital game-playing motivation in terms of the differences between female and male students. Düzce Univ J Sports Sci. 2022;2(1):45–60.

Çelebi E. The role of game addiction on motivation for the socialization process. Gumushane Univ J Facult Commun. 2020;8(1):643–68.

Hazar Z, Tekkurşun-Demir G, Namlı S, Türkeli A. Investigation of the relationship between digital game addiction and physical activity levels of secondary school students. Niğde University Journal of Physical Education and Sports Sciences. 2017;11(3):320–32.

Kaya N, Aştı T, Kaya İ, Yaylacı S, Kaya H, Turan N, Aydın GÖ. Association between attitudes of high school students toward internet usage and health practices in Turkey. East Mediterr Health J. 2016;22(11):824–31.

Leatherdale ST, Harvey A. Examining communication- and media-based recreational sedentary behaviors among Canadian youth: results from the COMPASS study. Prev Med. 2015;74:74–80.

Article   PubMed   Google Scholar  

Mustafaoğlu R, Yasacı Z. The negative effects of digital game playing on children’s mental and physical health. J Depend. 2018;19(3):51–8.

Işıkoğlu Erdoğan N. Is digital play popular? Examining parents’ play preferences for their children. Pamukkale Univ J Educ. 2019;46:1–17.

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Acknowledgements

The authors would like to extend to all nursing students who participated in this study.

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Nuray Turan: Methodology; Hasan Sağlam: Data collection; formal analysis; Nuray Turan: Conceptualization; supervision; writing-review and editing. All authors agreed to be accountable for all aspects of the work and have given final approval for the version to be published.

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All participants gave informed consent for inclusion before participating in the study. The Declaration of Helsinki conducted the study, and the protocol was approved by the Ethics Committee of Istanbul University-Cerrahpasa Project identification code 2020/70800, dated 13.10.2020. Before starting to collect data, written permission was obtained from the institutions where the research was conducted [Istanbul University-Cerrahpaşa Florence Nightingale Faculty of Nursing (14.09.2020/119213), Istanbul Medeniyet University Faculty of Health Sciences Department of Nursing (16. https://doi.org/10.2020/70734980-100-E.3701 ), Bezmialem. Retrieved from Foundation University, Faculty of Health Sciences, Department of Nursing (09.11.2020/5403). The authors confirm that all methods were conducted in accordance with the ethical principles.

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Sağlam, H., Turan, N. Investigation of nursing students' addiction to digital game play and associated factors. BMC Nurs 23 , 563 (2024). https://doi.org/10.1186/s12912-024-02244-w

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