2003 Conference Proceedings

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HOW ACCEESIBLE ARE BLODD GLUCOSE METERS FOR BLIND AND VISUALLY IMPAIRED PEOPLE?

Presenter
Mark Uslan
American Foundation for the Blind
949 Third Avenue
Huntington, WV 25701
Phone: (304) 523-8651
Fax: (304) 523-8656
Email: muslan@afb.net

Darren Burton
American Foundation for the Blind
949 Third Avenue, Suite 200
Huntington, WV 25701
Phone: (304) 523-8651
Fax: (304) 523-8656
Email: dburton@afb.net

Caesar Eghtesadi, Ph.D.
Tech For All, Inc.
P.O. Box 29
Wilton, CT 06897
Phone: (203) 775-3204
Email: keghtesadi@aol.com

Diabetes is a disease in which the body is unable to use and store glucose properly. It is a serious health problem in the United States--16 million people have the disease, and over 5 million of them experience some form of vision loss. Using devices that measure their blood glucose levels enables people to keep those levels within a normal range by taking a dose of insulin or eating a certain food. Blood glucose meters have revolutionized diabetes care by allowing individuals with diabetes to have more active control over their condition.

Why is an accessible blood glucose meter so important? The answer is simple: If you are not able to operate the meter and read the results, the meter is not usable. There are about 30 blood glucose meters on the market, including a few that have speech-output capability or can be used with a separately purchased speech module. Some visually impaired people may be able to use an off-the-shelf meter without speech output, but others with less vision need speech access to test their blood independently.

For this evaluation, we acquired and examined 16 blood glucose meters, including the ones that have speech output capability. We identified which meters to acquire by using published reports and physicians( recommendations. To help us understand the devices, we observed blind or visually impaired people using their blood glucose meters and then interviewed them. We identified the key features to look for in a meter, rated the meters that offer speech output and five that do not, and considered the state of the technology of blood glucose meters, including what next-generation devices may be like. For this paper we discuss how meters work and what to look for in a blood glucose meter. We also provide product information. The CSUN 2003 presentation will go into results of the product evaluation.

How a Blood Glucose Meter Works

Today's blood glucose meters use an enzyme found in the blood to measure glucose levels. The glucose in a drop of blood placed on a test strip reacts with the enzyme, and this reaction is measured by an electric current generated by the reaction. The conventional means of self-testing one(s blood glucose level is the finger stick method. To perform finger-stick blood glucose tests, you need a meter, a lancet device, disposable lancets that enable you to draw a drop of blood in a controlled way, and a set of test strips.

Before you use a blood glucose meter, you need to calibrate it to the test strips--every time you open a new container of test strips and before the first strip is used. Some meters require that you push a button until the number that appears on the screen corresponds to the number located on the test-strip container. Other meters use strips that come with an encoded key or strip that allows you to calibrate the meter by inserting the encoded key or strip into a slot in the meter.

After the test strip is inserted into the meter, a blood sample is obtained using the lancet device. Typically, you draw blood from the tip of the finger, but some newer devices allow you to use the forearm, upper arm, or thigh. Then, blood must be applied to the target area of the test strip, which is tiny--sometimes no larger than a few square millimeters. In 5 to 50 seconds, depending on the device, the blood glucose reading (a two- or three-digit number) appears on the meter's display.

Desirable Features of Blood Glucose Meters

Code Key Calibration

Although test-strip calibration is done only once with each new container of test strips, it can be a hassle to do, especially if you can(t see the meter display or the code on the container of test strips. Meters that use an encoded key or strip make life a lot easier.

Adjustable Lancet Depth

Each meter comes equipped with its own lancet device and a few disposable lancets. The lancet depth should be adjustable to control the puncture depth, an important feature for reducing discomfort and the need to repeat the test.

Blood Sample Size

Newer meters usually require from [Query: Are these numbers correct, or should 0.3 be 3.0? These numbers are correct] 0.3 to 4.0 microliters of blood--much less than the typical 10.0 microliter sample of older models. Since the manufacturers assume that verification of sufficient blood on the strip will be done visually, a smaller sample size gives the visually impaired user better odds of getting enough blood on the strip and reduces the need for retesting.

Capillary and Touchable Strips

The task of applying blood on a test strip can be difficult. It is particularly hard to do if the strips are so sensitive that you cannot touch the test area of the strips, which is the case with some meters. The task is made much easier if the meter uses touchable strips. In addition, it is also easier to apply blood on a strip if the strips are designed to take advantage of capillary action, which draws the blood on the strip.

Ability to Apply More Blood After the Test Starts

Some meters allow you to apply more blood to the test strip after the initial application, in case not enough was initially applied. This feature diminishes the need for retesting.

Cleaning

To remain accurate, some meters need to be cleaned of residual blood that may have gotten on sensitive parts of the meter. Other meters are designed so that these components are not exposed, thereby eliminating the need for cleaning.

Response Time

The response time is the amount of time it takes the meter to provide a reading after the blood is applied. Shorter times make testing less of a hassle in our fast-paced world.

Whole-Blood versus Plasma Readings

Plasma-calibrated meters convert whole-blood readings to plasma-equivalent values, the standard used by health professionals. Plasma-calibrated meters make it easier for patients and their health care professionals to keep track of their progress.

Size/Portability

Active people need the convenience of being able to put a meter into their pocket or pocketbook. Some meters are as small as a pager, while those with speech modules are much larger but still portable. Though all meters use small LCD screens that are not easy to view, the font size on the screens [Query: Is (on the screens( OK? Yes] is typically large and bold.

Accuracy and Consistency

The results of the tests of accuracy and consistency of 11 popular meters were published in the October 2001 issue of Consumer Reports. The article defined consistency as (the ability to give similar readings on successive tests of the same blood sample( and accuracy as (how closely the readings agreed with the standard lab results.( [Note: Add the page of quote from Consumer Reports ( pg. 38].

Downloading Capability

All meters have the ability to keep test results in memory. In some, the data can be downloaded to a computer and translated into charts or other simplified forms, which can be a helpful tool for patients and their physicians.

Cost

The average meter costs between $50 and $70, and many come with rebates that can significantly reduce the cost. However, expect to pay 5 to 10 times as much if you need speech. The small test strips on which the blood is applied are also a major cost component, especially if you need to test your blood many times a day. On average, they cost from 65 cents to 90 cents apiece, with a new one needed for each test. The disposable lancets must also be purchased separately, but they cost only a few cents apiece. Health insurance covers all the components but may limit the choices of meters.

Product Information (Products Evaluated)

Product: One Touch Ultra
Manufacturer: LifeScan
1000 Gibraltar Drive
Milpitas, CA 95035
phone: 800-227-8862
web site: www.lifescan.com
Price: $65.

Product: Accu-Chek Advantage
Manufacturer: Roche Diagnostics
9115 Hague Road
PO Box 50457
Indianapolis, IN 46256
phone: 800-858-8072
web site: www.accu-chek.com
Price: $65.

Product: FreeStyle
Manufacturer: TheraSense
1360 South Loop Road
Alameda, CA 94502
phone: 888-522-5226
web site: www.therasense.com
Price: $75.

Product: Prestige IQ
Manufacturer: Home Diagnostics
2400 N.W. 55th Court
Fort Lauderdale, FL 33309
phone: 800-342-7226
web site: www.prestigesmartsystem.com
Price: $15.

Product: Sof-Tact
Manufacturer: Abbott Laboratories
MediSense Products
Bedford, MA 01730
phone: 800-527-3339
web site: www.medisense.com
Price: $200.

Product: Accu-Chek Voicemate System
Manufacturer: Roche Diagnostics Corporation
9115 Hague Road, PO Box 50457
Indianapolis, IN 46256
phone: 800-858-8072
web site: www.accu-chek.com
Price: $495 to $525; Accu-Chek Compass Software: $29.99; Interface Cable: $30.

Product: One Touch Basic
Manufacturer: LifeScan
1000 Gibraltar Drive
Milpitas, CA 95035
phone: 800-227-8862
web site: www.lifescan.com
Price: $53; InTouch Software: free download from web site; interface cable: $19.99.

Product: One Touch SureStep
Manufacturer: LifeScan
1000 Gibraltar Drive
Milpitas, CA 95035
phone: 800-227-8862
web site: www.lifescan.com
Price: $65; InTouch Software: Free download from website; interface cable: $19.99.

Product: One Touch Profile
Manufacturer: LifeScan
1000 Gibraltar Drive
Milpitas, CA 95035
phone: 800-227-8862
web site: www.lifescan.com
Price: $113; InTouch Software: Free download from the web site; interface cable: $19.99.

Voice Units
Product: Digi-Voice for One Touch SureStep, Basic, and Profile
Manufacturer: CAPTEK sold by Science Products
Box 888
Southeastern, PA 19399
phone: 800-888-7400
Price: Digi-VoiceDeluxe $275, Mini-Digi-Voice $199($219)

Product: LHS-7 for the One Touch Profile
Manufacturer: LS&S Group
PO Box 673
Northbrook IL 60065
phone: 800-468-4789
web site: www.lssgroup.com
Price: $199


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