Diabetes and Visual Impairment: An Update on Accessible Blood Glucose Meters
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
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.
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.
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.
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.
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 areas:
- Obtaining a blood glucose measurement
- Accessing past readings in memory
- Warnings and error messages
- Low Vision Accessibility
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.
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.
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.
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.
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 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.
Prodigy Diabetes Care, LLC
P.O. Box 481928
Charlotte, NC 28269
24/7 Customer Care Center: (800) 243-2636
Sales: (866) 540-4786
BioSense Medical Devices
6555 Sugarloaf Pkwy, Suite 307-168
Duluth, GA 30097
Phone: (877) 592-3922
Fora V20 and Fora V22
810 Lawrence Drive, Suite 104
Newbury Park, CA 91320 USA
Phone: 1-888-307-8188 or (866) 469-2632
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