Diabetes and Visual Impairment: An Update on Accessible Blood Glucose Meters

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AccessWorld ®

Technology and People Who Are Blind or Visually Impaired

February 2012 Issue Volume 13 Number 2

Product Evaluations

Diabetes and Visual Impairment: An Update on Accessible Blood Glucose Meters

Darren Burton, Lilly, Enigk, and Ricky Kirkendall

Because of the close relationship between diabetes and vision loss, we in the

AFB Tech product evaluation lab periodically track the accessibility of the

blood glucose meters used to help manage diabetes. Since our January 2008

AccessWorld article on the subject, the number of Americans with vision loss who

have diabetes has risen from 3.2 million to 3.9 million. In the same time

period, the number of accessible meters available on the US market has also

increased; this article reports on the accessibility of those new meters.

In 2008, we reported that there were five meters available with speech output,

but only one of those had comprehensive speech output that supported the

independent use of all of the features available on the meter. This time around,

we found 13 meters that had speech output, and four of those have comprehensive

speech output supporting all features. This article focuses on those four

meters:

The Prodigy Voice from Prodigy Diabetes Care

The Solo V2 from BioSense Medical Devices

The Fora V20 from Fora Care, Inc

The Fora V22 from Fora Care, Inc

Product Descriptions

Prodigy Voice

The Prodigy Voice ($40) originally came on the market in 2007, and has since

been updated. The meter weighs 2.4 ounces and measures 2.2 by 4.0 by 0.8 inches.

The front panel has a 1.2-inch by 1.5-inch monochrome black-on-gray display with

three control buttons below and two directional buttons to the right. The round

power button, also used to enter Memory Recall mode, is in the right-most

position of the control buttons, has a raised " M, " and is larger than the rest

of the buttons. The triangular Settings button is the center control button and

has a raised " S " on it. The Repeat button is the left control button and has a

raised, left-pointing arrow on it. The Repeat button is used to repeat the last

spoken message or test result. The speaker is located below the control buttons.

The directional buttons located to the right of the display have raised up and

down arrows and are used to select test results and change settings. The Prodigy

Voice has a 3.5-millimeter headphone jack near the bottom right side panel of

the meter, which allows you to connect headphones for privacy or a speaker for

amplification. A mini-USB port below the headphone jack allows you to download

the meter's test results to a computer using Prodigy's download software. There

is also a slot on the bottom left side panel to attach a lanyard for easy

carrying.

Fora V20

The Fora V20 from Fora Care, Inc. ($70) weighs 2.08 ounces and measures 3.69 by

2.25 by 0.78 inches. The front panel has a 1.2-inch by 1.5-inch monochrome

black-on-gray display with three buttons below the display, two directional

buttons to the right of the display, and a strip eject slider on the top right

side panel. The Power button is the right-most control button and has a raised

circle with an " M " in the center. This button can be used to turn the meter on

and off and activate the Memory Recall mode. The Settings button is the middle

of the three control buttons and has a raised square with an " S " in the center.

The Recall button is the left-most control button and is used to repeat the last

spoken message or test result. It has a raised arrow pointing to the left. The

directional buttons are located to the right of the display and have raised

arrows pointing up and down. The directional buttons are used to select

different test results in the Memory Recall mode and to change settings. The

speaker is located below the Repeat and Settings buttons. An eject slider,

located on the top right side panel, ejects test strips when pushed up. A

standard 3.5-millimeter headphone jack on the bottom left side panel allows you

to connect headphones for privacy or a speaker for amplification. Below the

headphone jack is a data port with a rubber cover that reads " PC " in raised

letters. The data port is used with the Fora software to download test results

to a computer. There is also a slot for a lanyard on the bottom right side

panel.

Fora V22

The Fora V22 from Fora Care, Inc., ($80) weighs 1.76 ounces and measures 3.75 by

2.00 by 0.44 inches. The Fora V22 has a 1.2-inch by 1.6-inch circular screen

with the strip eject slider to the left and the rest of the buttons below the

display in a circular layout. In the center, the power button is recessed a

little and labeled with a non-tactile " M. " As with the previously discussed

models, the power button on the V22 is also used to access Memory Recall mode in

order to speak previous test results. To the right of the power button are the

Repeat and Settings buttons. The Repeat button is located above the settings

button and is used to repeat the last spoken message or test result and is

labeled with a non-tactile arrow pointing to the left. The Settings button is

located below the Repeat button and is labeled with a non-tactile " S. " To the

left of the power button are the directional buttons, labeled with non-tactile

up and down arrows, which are used to select different test results and

settings. The speaker is located directly below the power button. The Fora V22

features a built-in rechargeable battery. A recessed LED light centered on the

right side of the front panel indicates the charging status of the meter. If the

meter is plugged in and charging, the LED is red; if the meter is plugged in and

finished charging, the LED is green. To the left of the display is a test-strip

eject slider with raised bumps; push the slider up to eject a used test strip.

On the bottom panel, there is a 3.5-millimeter headphone jack on the right that

can be used with headphones for privacy or speakers for amplification. On the

left side of the bottom panel is a mini-USB data port covered by a rubber flap

with a raised lightning bolt symbol and raised USB symbol. The port is used for

charging the battery and downloading information to a computer using Fora's

software. On the right corner there is a slot for a lanyard.

Solo V2

The Solo V2 from BioSense Medical Devices ($17) weighs 2.2 ounces and measures

3.92 by 2.16 by 0.71 inches. The Solo V2 has a 1.5-inch by 1.9-inch monochrome

black-on-gray display with two buttons below the display and three buttons on

the top of the right side panel. The power button is the left button located

below the display. It is used to turn the meter on and off and to recall

previous test results. It has a non-tactile icon that resembles a calendar. The

repeat button is the right button located below the display. It is used to

repeat the last spoken message or test result and has a non-tactile arrow

pointing left. The buttons below the display are connected in the middle and are

not actually physically separated from each other. The speaker is located below

these buttons. On the top of the right side panel are two directional buttons

and one button for settings. The directional buttons are located at the very top

and have raised arrows pointing up and down. They are used to select different

test results, change settings, and increase or decrease the volume. The settings

button, which is small and circular, is located below the directional button on

the top right side panel. On the bottom of the right side panel, there is a

mini-USB data port used for downloading test results to a computer using

BioSense Medical Devices' software.

Evaluation Methodology

As with our past evaluations of blood glucose meters, we evaluated how easily a

person who is blind or has low vision could perform each task and access each

feature and function of the meters. We evaluated each meter in the following

seven are as:

Obtaining a blood glucose measurement

Accessing past readings in memory

Settings

Software

Documentation

Warnings and error messages

Low Vision Accessibility

Results

Although all four meters have high-quality recorded human speech that supports

all of their features and functions, there are some differences in overall ease

of use.

Obtaining a Blood Glucose Measurement

The process of obtaining a blood glucose measurement is fully accessible on all

four of these meters, with speech output supporting the process the entire way.

All models:

Speak test results in only 6 or 7 seconds

Have a repeat button in case you miss something that is spoken

Alert you if your reading is out of the normal healthy range

Automatically work with their strips (no need to code the meter for each new

bottle of strips)

Use strips with capillary action, which pulls your blood sample into the strip,

eliminating the need to place a large hanging drop of blood onto the strip

Have a tactile notch to indicate where to insert the strip; the strips protrude

enough from the meters so that you don't have to clean the meters after use

All four meters require a small sample of blood: the Prodigy Voice requires 0.6

microliters and the others require 0.7 microliters. The two Fora meters have a

handy eject button, so you can dispose of used strips without touching them. All

but the Solo V2 have a headphone jack, which is useful for private use or for

attaching speakers to amplify the speech for a person who is hard of hearing.

Although it can be difficult to quantify how tactually identifiable a control

button is, the buttons on the Prodigy Voice and the Fora V20 are definitely the

easiest to distinguish from one another non-visually. The Solo V2's Memory and

Back buttons are right next to each other and were somewhat difficult to

distinguish from one another. Although the buttons on the Solo V2 for adjusting

the Settings are easy to feel, it does take considerable force to activate them.

Most of the buttons on the Fora V22 are nearly flush with the panel and so are

difficult to feel and activate non-visually. However, even though the buttons on

the Solo V2 and Fora V22 can be somewhat difficult to use, proper practice

should make those meters usable with no problems.

Accessing Past Readings in Memory

The memory functions of the Prodigy Voice and both Fora meters are fully

accessible and supported entirely by speech output. It's easy to scroll through

the individual records to hear the glucose level, time, and date for each

reading. The memory function of the Solo V2 is not quite as fully accessible,

because it will not speak the time of each reading, even though the time is

shown visually on the display screen. All four meters will speak their 7, 14,

21, 28, 60, and 90 day averages, and the Solo V2 can hold 500 readings in memory

while the others can hold 450 readings.

Settings

The process for adjusting the various settings on all of these meters is

accessible, with speech supporting all the steps along the way.

On the Prodigy Voice, you can adjust the volume, date, and time, and you can

choose between mg/dL and mmol/L as the measurement unit. The Prodigy Voice's

settings also allow you to delete your readings from memory. The Fora and Solo

V2 meters include those settings and an additional language setting, and the

Solo V2 also has an alarm setting as well.

Software

All four meters have free software available for transferring results to a PC.

The software creates charts and graphs for monitoring your test history and

prepares reports that you can send to your health care provider so he or she can

track your blood sugar levels over time.

The PC software for the two Fora meters is not compatible with screen reading

technology at all, but parts of the Prodigy Voice and Solo V2 software are

compatible. The Prodigy Voice has more compatible components than the Solo V2.

Although neither allows a screen reader user to access reports of test results,

both can export the reports to accessible spread sheets.

Documentation

The Prodigy Voice, the Solo V2, and the Fora V22 all have manuals available in

an electronic format that is compatible with screen reading software used by

people with vision loss. The electronic manual for the Fora V20, however,

contains several graphics and important instructions that can't be accessed.

Warnings and Error Messages

All four meters speak the warnings and error messages that are occasionally

displayed on their screens. You know that you've inserted a strip incorrectly

when the meters do not speak their instructional messages after insertion. The

Prodigy Voice and Solo V2 also have the added benefit of a " Not enough blood "

warning, which can help people with vision loss avoid false low test results.

Low Vision Accessibility

All of these meters feature monochromatic displays with large fonts that should

be readable by many people with low vision. The Solo V2 leads the way with very

large, 1- inch tall characters; the Prodigy Voice's display uses 0.63-inch

characters; the characters on both Fora displays are 0.55 inches tall. Contrast

is another strong indicator of readability, and the Prodigy's display leads the

way with a high 83.6% contrast ratio. The Solo V2 has a fairly high contrast

ratio at 73.9%; the Fora meters have a low 53% ratio. Of course, the speech

output on these meters will accommodate a person whose vision is such that he or

she cannot read the display screen.

As far as the visual nature of the other physical characteristics of these

meters, our testers with low vision said that the labels on the buttons are too

small for most people with low vision to read. Also, the button labels on both

monitors are nearly the same color as the buttons themselves, providing no

contrast to accommodate the reader with low vision. Many people with low vision

may need to use tactile methods to identify and use the buttons on these meters.

The Bottom Line

All four of the meters evaluated in this article are usable by people with

vision loss, but the testers in our AFB Tech labs found the Prodigy Voice to be

the most accessible of the four. Overall, the Prodigy Voice did a bit better

than the others in the seven areas we tested.

Things have certainly improved with blood glucose meter accessibility since we

began tracking it in our AFB Tech labs nearly ten years ago. Back then, meters

all had displays with poor readability, and the only meter with speech output

that used modern technology was a large $500 contraption you had to carry around

in a backpack. Now we have four highly portable meters with comprehensive speech

output from which to choose, and all of them have improved visual displays. That

said, none of these talking meters are among the most popular in use today; none

of the four we tested are among the top selling meters as listed by Amazon.com.

This is an ongoing problem for people who have diabetes and vision loss, because

the most popular meters, such as the Accu-Chek Compact and the One Touch Ultra

2, are far more likely to be prescribed by physicians and are also more likely

to be covered by insurance carriers. When the leading BGM manufacturers build

accessible meters, more people with vision loss will have greater access to the

proper tools to independently manage their diabetes.

Resources

The Websites we provide in the next section for both the Prodigy Voice and Solo

V2 contain some very useful training resources. Also, AFB's own Center for

Vision Loss has developed the following resources:

Diabetes Basics

Diabetes and Vision Loss

The Carroll Center has added a third course on diabetes to its online offerings.

Diabetes and Visual Impairment: A New View for Health Professionals is currently

free, accessible to all who wish to enroll, and various accrediting agencies

provide continuing education credits.

Product Information

Product: Prodigy Voice.

Prodigy Diabetes Care, LLC

P.O. Box 481928

Charlotte, NC 28269

24/7 Customer Care Center:

Sales:

Product: Solo V2.

BioSense Medical Devices

Phone:

E-mail: info@...

6555 Sugarloaf Pkwy, Suite 307-168

Duluth, GA 30097

Product: Fora V20 and Fora V22.

Fora Care, Inc.

810 Lawrence Drive, Suite 104

Newbury Park, CA 91320 USA

Phone: 1- or

E-mail: service@...

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