As has been reported in three previous articles in AccessWorld on the accessibility and usability of diabetes self-care devices, diabetes is a serious health concern with a close relationship to vision loss. Because of this close relationship, one would assume that self-care devices would be accessible and that people who are visually impaired could use them independently as part of their diabetes care regimens. However, the three previous articles painted a different picture. The first article, on diabetes technology, in the September 2002 issue, reported that of the roughly 30 blood glucose monitors on the market, only 1 uses modern technology and is accessible, but its price is 10 times that of the inaccessible monitors. In the second article, in the March 2004 issue, none of the insulin pumps that were evaluated was found to be accessible.
The third article, in the September 2004 issue, reported that three accessible home blood pressure monitors (HBPMs) with speech output were taken off the market by their manufacturers because they were not selling. Currently, there are only two HBPMs on the market that use the more accurate upper-arm technology and have speech-output capabilities—the A&D Medical UA-767T (reviewed in the September 2004 article) and the Maxi-Aids Reizen (formerly known as the Shengfu SF860, which was discussed in the sidebar to that article; see the Product Information section of this article for contact information for ordering these monitors).
Caption: Currently, there are only two HBPMs on the market using the most accurate technology that have speech-output capabilities—the A&D Medical UA-767T (top) and the Maxi-Aids Reizen (bottom).
Those of us at AccessWorld and AFB TECH (the American Foundation for the Blind Technology and Employment Center at Huntington, West Virginia) were curious why there are so few options available for people who are visually impaired to manage their diabetes independently. We assumed that because one-third of Americans with diabetes also have some degree of vision loss, manufacturers would be eager to compete for that large market sector. Perhaps manufacturers have simply overlooked this market, but perhaps there is simply not enough demand by people who are visually impaired. We were particularly interested in the case of HBPMs. Why would three of the accessible monitors be taken off the market at a time when research studies and physicians have stated that monitoring blood pressure is as important as monitoring blood sugar for people with diabetes? Are health care providers not passing this information on to people who are visually impaired? Are they not recommending accessible HBPMs? Do they know that accessible HBPMs exist? Is that why there is not enough demand for accessible products?
The Surveys
To try to answer these questions, we created a 16-question survey that was aimed at certified diabetes educators (CDEs), the health care professionals who train individuals in proper diabetes management. The questions were designed to find out if CDEs recommend home blood pressure monitoring and if they were aware of accessible HBPMs for people who are visually impaired. We also asked the readers of our AccessWorld Extra publication to answer these three questions:
- Has a physician or other health care professional ever recommended to you that you take your blood pressure at home?
- Has a physician or other health care professional ever recommended a specific HBPM?
- Have you ever tried to purchase or use an accessible HBPM with voice output?
Once the CDE survey was created and a pilot study was completed, a population of qualified CDEs was established. To ensure that the sample was representative of qualified CDEs, we established contacts from a list of members of the American Association of Diabetes Educators. The sample was modified in an attempt to include specialists in diabetes education of people who are visually impaired. After contacting several clinics and visual impairment rehabilitation and information services, we discovered that there are few CDEs who specialize in caring for people who are visually impaired. To strengthen our sample, we found more qualified individuals with a greater knowledge base through recommendations from rehabilitation services and other diabetes educators.
Low Returns
Overall, 34 diabetes educators were contacted by telephone, usually at the clinics where they worked, in an attempt to create the most qualified sample. Of the 34 CDEs with whom we spoke or left messages, only 9 agreed to complete the survey.
Results
Even though every participant agreed that blood pressure monitoring is an important part of overall diabetes care, five of the nine do not recommend or give out HBPMs. Only one participant recommended a specific brand of HBPM, and she admitted that she did so only because it was a free model that was part of a manufacturer's promotion. The other three participants who recommend home blood pressure monitoring refer their patients to a pharmacist or other professional for recommendations about models. Although all nine participants have had at least minimal experience with patients with diabetes who are visually impaired, only one had received any formal training in adaptive diabetes care education. Three admitted that they usually recommend that their patients who are visually impaired receive help from a sighted person, rather than learn self-care for their diabetes. Six would offer training in the use of HBPMs, but they all agreed that they would like to receive more information and better training in HBPMs themselves.
Of the three readers who responded to our AccessWorld Extra questions, all had been told by their health care professionals to check their blood pressure at home, but none was advised to purchase an accessible HBPM. One reader did purchase an accessible monitor, but he found it on his own, without advice from his health care provider.
The Bottom Line
Our survey of CDEs and the questions we asked AccessWorld Extra readers were informal surveys and do not provide hard scientific evidence. However, they do provide strong anecdotal evidence that health care providers are unaware of the existence of accessible HBPMs. Although they are obviously aware of the importance of blood pressure monitoring for their patients with diabetes, health care providers are not passing that information on to their patients who are visually impaired in an effective manner. Simply telling a person who is visually impaired to monitor his or her blood pressure at home does no good unless an accessible monitor is recommended. Relying on pharmacies to provide these HBPMs is also ineffective because the demand for accessible HBPMs needs to increase before pharmacies will regularly stock them. Currently, accessible HBPMs with speech output are sold only at specialty stores, such as Independent Living Aids and Maxi-Aids.
One particularly disturbing finding was that three of the nine diabetes educators recommended that their patients who are visually impaired get help from a sighted person, rather than learn self-care for their diabetes. Also, several of the educators we contacted said that they were unwilling to participate in the survey because they were inexperienced in working with people who are visually impaired. It seems that diabetes educators experience a level of discomfort in teaching self-care to people who are visually impaired. Their discomfort could inhibit proper diabetes self-care for their patients. A great deal of work goes into properly managing diabetes, and if you have to rely on sighted assistance every step of the way, it will most likely not be done properly. Individuals must take full responsibility for managing their own diabetes, so it is essential that they be able to do so independently.
The findings of our survey point out that there is a large gap between the theory of proper diabetes management and what is actually practiced by the health care professionals who treat people who are visually impaired. There must be both more accessible diabetes management devices on the market and more awareness among health care professionals of what is available. Diabetes educators must also become more comfortable and practiced in teaching self-care to the increasing number of people who are visually impaired who have diabetes. How can someone properly and independently manage his or her diabetes if health care professionals are unaware of how it can be done? If health care professionals were more aware of how to treat and advise their patients who are visually impaired, perhaps these individuals would purchase the few accessible products that are on the market. The pharmaceutical industry might then realize that there is a real demand for accessible products and decide to serve this overlooked market.
We at AFB certainly do not have all the answers to how the knowledge and awareness of health care providers can be improved, but we will continue to work to increase the accessibility of diabetes self-care devices. We always send the results of our product evaluations directly to the manufacturers and ask for their comments. We also publish our results in the medical journal Diabetes Technology and Therapeutics, and we attend the journal's annual conference and present our results at poster sessions. In addition, AccessWorld Solutions, the consulting arm of AFB, is working with manufacturers of diabetes devices to show them how to design their products with accessibility in mind. We also ask that you, our AccessWorld readers, do what you can to help educate your health care providers. Mention to them that accessible self-care devices do exist and that with proper training, people who are visually impaired can indeed manage their own health care independently.
Product Information
Product: A&D Medical UA 767T
Manufacturer: A&D Medical (Lifesource), 1555 McCandless Drive, Milpitas, CA 95035; phone: 408-263-5333; e-mail: <support@lifesourceonline.com>; web site: <www.lifesourceonline.com>.
Retail Vendor: Independent Living Aids, 200 Robbins Lane, Jericho, NY 11753; phone: 800-537-2118; web site: <www.independentliving.com>.
Price: $149.95.
Product: Maxi-Aids Reizen Talking Blood Pressure Monitor Kit (formerly called the SF860 by Qingdao Shengfu Electronics Company).
Retail Vendor: Maxi-Aids, 42 Executive Boulevard, Farmingdale, NY 11735; phone: 800-522-6294; web site: <www.MaxiAids.com>.
Price: $139.95.
