Accessibility of blood glucose monitoring systems for blind and visually impaired people.

Blindness and visual impairment are prevalent among people with diabetes. Blood glucose monitoring systems (BGMSs) have revolutionized diabetes care, but none of the 30 or so commercially available monitoring systems was designed to be fully accessible to blind and visually impaired persons. Seventeen BGMSs were evaluated for accessible use by people who are blind or visually impaired. Features and functionalities (e.g., operating procedures, user interface design, device specifications, and computer interface capabilities) were examined and tabulated, as was usability and accessibility. A subset of these systems with the highest degree of accessibility was selected and thoroughly examined and tested. Additionally, 12 people who are blind or visually impaired and who were issued BGMSs by their physician or diabetes educator were interviewed and videotaped using their meters. Of the 17 BGMSs, only four had voice output capability, an essential component of accessibility for blind and visually impaired persons. The six BGMSs without voice output that had the largest display fonts were found to have few accessibility features for visually impaired persons. Users indicated that voice output and portability were desired attributes of an accessible BGMS. None of the BGMSs evaluated had all of the required accessibility attributes, including the four systems that had voice output capability. The four systems with voice output were much bulkier and heavier than those that did not have this capability. Recommendations are made for design and development of BGMSs that would increase effective usage by blind and visually impaired persons, including integrating text to speech and streamlining the blood glucose monitoring process.