Type 1 diabetes often strikes children. Children love to play video games. Putting two and two together, diabetes educators have created a string of diabetes-themed video games over the years. The latest evolution of that simple equation--the Bayer Didget meter-game combination--arrived in U.S. drugstores this year.

But can fun and disease education work together? Can they create compelling games or compelling education? Or are those even the right questions to ask?

Bayer is marketing the Didget device less as recreation and more as solution. The meter "was designed to directly address the challenges facing kids with diabetes and their parents, and may also ease the tensions that testing can cause for families," said Erika Muhlberg, a Bayer spokeswoman.

The Didget device lives in a couple of different worlds. On one hand, it's a blood glucose meter, built with the company's no-coding technology. On the other hand, it can plug into a slot on the Nintendo DS handheld game machine. When attached, its users can play a series of minigames on the machine.

As children test more often, they unlock more games. They're rewarded for developing the kind of habits required for tight control of diabetes.

The current set of games available with the meter, carnival-themed diversions called "Knock ‘Em Down," has garnered a positive response from young users, Muhlberg said, but "Bayer is currently working with Nintendo to develop more games compatible with the meter."

Didget came out in Europe last year and was approved for the U.S. in December. Muhlberg said that the company plans to continue rolling out the meter worldwide.

They may be racing against time, though. Last year, Nintendo introduced the DSi, a handheld gaming device that took out the slot necessary for the Didget meter. In June, Nintendo introduced another successor device, the 3DS, which also lacks the hardware slot used by the meter.

Muhlberg said that Bayer plans to "keep the Didget meter compatible with new gaming systems as they are introduced."

Some Context

Parents and educators may be surprised at the size and breadth of the video game market. According to the Entertainment Software Association, the industry's trade group, U.S. video game sales in 2008 totaled $11.7 billion.

What's more, 68 percent of the country's households play video games. The average gamer in those homes is 35 years old and has played games for a dozen years.

And in this entire, vibrant market, a small handful of educational games have left a mark. Where in the World Is Carmen Sandiego, a series of PC geography games, perhaps came closest. Oregon Trail, a grade school-level history game, has its devotees. Nintendo itself, in recent years, has introduced "brain training" games for the DS.

In this wider video game community, two diabetes-themed adventures produced for the Super Nintendo system in the 1990s have come in for considerable mockery. Electronic Gaming Monthly magazine included the running-and-jumping Captain Novolin as one of its 20 worst games of all time. It came in at No. 4.

According to EGM's Seanbaby (pen name of writer Sean Reiley), "For this game to have had any use whatsoever, there would have to be at least one pediatrician who left the education of a potentially deadly affliction up to an unplayable video game."

Another SNES game, Packy & Marlon, stars two diabetic elephants at summer camp. The bitingly sarcastic website Something Awful has featured the game, writing that "game developers took the steps necessary to push children over the edge so they would forcefully end their lives with a lancet to the eyeball."

Perhaps this is all unfair. For an educational video game, fun is not the primary purpose--it's a way to make players receptive to a message. But if kids are learning about video games from this wider community, and from parents who play games themselves, surely they have the right to expect enjoyable experiences.

Those developing and promoting the latest generation of diabetic education games aren't making new Captain Novolins or Packy & Marlons--games that attempt to disguise, however poorly, their educational missions. They're drawing distinctions. Sometimes, they're not even calling the products games.

Bayer's Erika Muhlberg said that the Didget meter is "first and foremost a healthcare device regulated by the FDA."

Nikki Inderlied of Game Equals Life, which is developing a role-playing action game starring a diabetic hero, calls her company's effort "an educational tool."

In Development

Two other diabetes-themed video games in development have garnered notice over the past few years.

Game Equals Life, based in Norman, Oklahoma, is working on a project called The Magi and The Sleeping Star. Inderlied, a company spokeswoman, said the game integrates diabetes management into a wider story.

"The game is about a hero who must battle armies of robots and giant monsters in order to save his world," she said. "But since this hero happens to have type 1 diabetes, players must learn to manage the disease in order to be successful."

Adam Grantham, the company's president and creative director of the game, demonstrates Magi on the company's website. Grantham, a type 1 diabetic himself, has created what looks like a mainstream, action-oriented title.

As in most video games, the main character gains powers and abilities throughout play. But in this one, improving his diabetes management adds to his power.

"We're using the incredible teaching power of play to illustrate that life with type 1 diabetes doesn't have to center around the disease, and that good blood sugar management is the key to living a free and healthy life," Inderlied said.

The game is being developed for the personal computer, and Game Equals Life is looking for development partners. No release date has been set, Inderlied said.

The games mentioned so far, both old and new, set their sights on type 1 diabetics. Richard Buday's company, Archimage, is behind two recent projects--Escape from Diab and Nanoswarm: Invasion From Inner Space --targeting young people at risk for type 2 diabetes.

Buday's company, originally a design firm, has expanded into assisting with video game development for companies such as Disney and Nintendo. A decade ago, the company began working with Baylor College of Medicine on National Institutes of Health-funded work on interactive behavior modification.

Inspired by Baylor's work, Archimage applied for its own NIH grant and received $9 million to help develop Diab and Nanoswarm, each of which tries to prevent childhood obesity through "role-playing, character-driven sci fi adventures," Buday said.

But he doesn't want players glued to the screen, especially when they need to be active. "The games are designed specifically to limit each level to an hour or so of screen time," Buday said.

ArchImage received its grant in 2003 and began a clinical trial in 2008. The research, conducted by Baylor, showed that Diab and Nanoswarm players ate an extra serving of fruit and vegetables a day. The results have been written up and submitted for journal publication.

Buday is currently working on partnerships with businesses or institutions "to get this out of researchers' hands and into kids' hands." Archimage is also looking for a second grant for a larger trial.

The challenges of educational gaming are many. Not only do the games have to appeal to children with other,  noneducational, options, but they also have to be supported by adults who may be unfamiliar with the video game world or video game culture. Will current projects be mocked online a decade from now? Or will they be seen as the start of a new and profound way to educate?