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Talking Meters
What’s New?

by Ann S. Williams, Ph.D., R.N., C.D.E.

Self-monitoring of blood glucose is one of the areas of diabetes self-management that is deeply affected by severe visual impairment. When people with diabetes learn they have permanent visual impairment, one of the first questions they often ask a diabetes educator is, “How will I check my blood glucose?”

Many standard meters now have large-print screens, which makes them more accessible for people with enough vision to see large print. However, most of the large-print screens have low contrast between the
numbers and the background, limiting their usefulness for many people with moderate to severe visual impairment. And all standard meters currently available require the ability to read large print for at least some essential steps in their use, making them inaccessible for people whose visual impairment is severe enough that they cannot read large print.
Fortunately, some manufacturers of blood glucose meters have recognized the need for meters for people who cannot read visual displays. For more than 10 years now, such meters have been available in the United States. And Medicare and most private insurance companies provide coverage for such meters for the people who need them. (See “Insurance Coverage for Talking Meters.”)

In the past couple of years, there have been major changes in the availability of accessible blood glucose meters for people with severe visual impairment. A number of accessible meters are no longer available. One meter that had been available since 1998, the Accu-Chek Voicemate, ceased being produced as of January 1, 2007. Two other meters that could be used with a separate voice attachment, the OneTouch Profile and OneTouch SureStep, are also no longer sold.

However, a variety of both new and familiar meters are on the scene. The OneTouch Basic, its voice attachment, and the Sure Guide (a device that helps place the drop of blood on the strip) are all still sold. And several new lines of talking meters are now available. These new meters are smaller, faster, and less expensive than older choices, and they need only a tiny drop of blood, making them much easier to use accurately.

If you have visual impairment, you may be wondering which of these meters is the best one. The answer is not simple; each person with visual impairment has a slightly different set of needs, and each of the talking meters has somewhat different characteristics. Put simply, the most suitable meter for you is the one that best matches your needs. This article explains some of the different features of the talking meters, so you, your diabetes educator, and your doctor can decide together which one is best for you.

What meter features are important?

People who use talking blood glucose meters need many of the same features in a meter that sighted users need. In addition, they need a few special features that relate to their inability to see. The following list includes questions that should be asked about both types of meter features.

While each question is important to some people, not every question is important to every person who needs a talking meter. As you read the questions, think about which ones are important to you.

  • How big is the meter with its integrated voice or its voice attachment? Can it be carried easily in a pocket or purse?
  • What is the cost of the meter?
  • Where can the meter and strips be purchased?
  • Is the meter’s voice clear and easy to understand?
  • Does the voice speak any language other than English?
  • Can the volume be adjusted? Is there an earphone to allow private use in public places?
  • If there is a separate voice attachment, does the same company manufacture both the meter and the voice?
  • If the voice needed repairs, would it be serviced by the meter company or by a separate company?
  • How big are the strips?
  • Are the strips easy to handle?
  • Is it easy to identify the insertion end of the strip nonvisually?
  • Are the strips easy to insert in the meter nonvisually?
  • Does the manufacturer provide accessible instructions (recorded instructions, for example) for the use of the meter?
  • Does the voice guide the user through all of the steps for a blood glucose check?
  • Does the meter require coding? If it does, can it be coded without seeing the code number?
  • How large a drop of blood is needed for an accurate test?
  • Is it easy to place blood on the right place on the strip nonvisually?
  • How long does the procedure for checking blood glucose take?
  • Does the meter read the result clearly? Can the user hear the result repeated if necessary?
  • Does the meter store the result, date, and time in the memory? If so, how many results can be stored?
  • Can the voice repeat information from the meter’s memory?
  • Can data in the meter’s memory be uploaded to a computer?
  • Does the meter do anything besides measuring blood glucose levels?

Accu-Chek Voicemate

Size of meter: 6.50″ x 3.00″ x 2.50″: too large to carry easily in a pocket or purse. The meter comes with its own carrying case with a shoulder strap.

Cost of the meter: about $500.

Meter and strip availability: As of January 1, 2007, the manufacturer, Roche Diagnostics, is no longer shipping new meters to retailers. However, some meters may still be available through select medical equipment suppliers. Roche will continue to supply the Voicemate by special request from physicians for people who have an urgent need for it, and the company plans to keep the strips available indefinitely in pharmacies and from durable medical equipment companies. (See “Resources” for contact information.)

Clarity of the meter’s voice: Clear, easy to understand.

Available languages: English or Spanish.

Volume: Adjustable. Comes with an earphone that allows private use in public spaces.

Repairs: The meter and the voice are produced by the same manufacturer, so if either malfunctions, it can be repaired by the same source.

Size of the strips: about 1.70″ x 0.40″.

Ease of handling strips: Easy to handle, even for people with some dexterity problems.

Insertion of strips: The insertion end of the strip is easily identified as being farthest away from the rounded cutout area where the blood is placed, with the cutout positioned to the right. The strip is easy to insert in the meter nonvisually.

Accessible instructions: Complete audiotaped instructions come with each meter. The voice guides the user through all steps of a blood glucose check.

Coding: Requires coding, which can be accomplished nonvisually by the insertion of a code chip that is included inside every box of strips.

Size of blood drop: 4 microliters of blood are needed for an accurate test—a relatively large drop compared to many modern meters. (See “Getting a Blood Drop Onto a Strip” for suggestions on how to get an adequately sized blood drop.)

Placement of blood drop: Each strip has a rounded cutout area near one end that identifies tactilely where the blood drop should be placed. The strip pulls the blood in from the side, and the user can add more blood for up to 15 seconds. The meter beeps when enough blood has been applied. Although the meter is not supposed to begin its countdown if an inadequate sample is applied, it is possible for the meter to beep and begin its countdown when not quite enough blood has been applied, resulting in an inaccurately low reading.

Time for results to appear: Varies, but it is usually 30–40 seconds—relatively long compared to most modern meters.

Results: The meter speaks the results clearly, and they can be repeated by pressing a button.

Meter’s memory size: Retains the most recent 100 readings, with the date and time of each reading.

Memory accessibility: The memory can be accessed by the voice.

Computer interface: Information can be uploaded to a computer with a purchased cable and software. However, the software program is not accessible with a computer screen reader.

Extras: Has a bar code reader that identifies types of Eli Lilly insulin in vials.

Advocate and Advocate Redi-Code

Size of meter: 3.70″ x 1.90″ x 0.90″: easily carried in a pocket or purse.

Cost of the meter: about $30.

Meter and strip availability: Distributed by Pharma Supply (see “Resources” for contact information). Also available through select durable medical equipment companies and suppliers of accessible equipment for people with visual impairment.

Clarity of the meter’s voice: Clear, easy to understand.

Available languages: English or Spanish.

Volume: Can be adjusted, although this is difficult to do nonvisually. Does not have an earphone to allow private use in public spaces.

Repairs: Voice and meter are one entity, so if either malfunctioned, it would be repaired by the same distributor.

Size of the strips: About 1.30″ x 0.30″.

Ease of handling strips: Easy to handle for most people. Some people with dexterity problems may have difficulty.

Insertion of strips: The insertion end has squared corners, and the end that sticks out of the meter has rounded corners. (See “Strips: Which End Is Which?”) The strip is easy to insert nonvisually. Although it can be inserted upside down, doing so does not turn on the meter.

Accessible instructions: No audio instructions are provided with this meter. The voice guides the user through the steps for checking blood glucose levels, but instructions for other meter functions such as coding or changing the volume are not available in a nonvisual format. Coding is not necessary for the Advocate Redi-Code.

Coding: Coding is required on the Advocate, and the code number is not available nonvisually. The distributor says that if a visually impaired user orders strips from them, they will ensure that they always send the same code number, eliminating the need for recoding. However, for safety, sighted verification of the code number before use would be a good idea. No coding is required on the Advocate Redi-Code.

Size of blood drop: 0.6 microliters.

Placement of blood drop: The strip pulls in the blood drop through a tiny opening at the end that sticks out of the meter, which is easy to locate. However, for a user who has very low or no vision, remembering where the blood drop is on the finger and applying it to the strip can be difficult. (See “Placing Blood Accurately on the Strip” for suggestions.)

Time for results to appear: 6 seconds.

Results: Voiced clearly, but cannot be repeated.

Meter’s memory size: Can store up to 450 memory results, with the date and time of each reading.

Memory accessibility: Readings stored in the memory can be displayed on the screen only and are not accessible by speech.

Computer interface: The distributor has free software available on its Web site for uploading the data from the meter to a computer via a purchased cable. However, the software program is not accessible with a computer screen reader.

Extras: The meter gives the room temperature during the startup procedure.

OneTouch Basic, Profile, and SureStep

Size of meter: About 4.50″ x 2.60″ x 1.80″ for meter and voice attachment combined.

Cost of the meter: Speech box only, about $200; speech box with meter, about $240.

Meter and strip availability: The OneTouch Basic is available through many durable medical equipment suppliers. The OneTouch Profile and SureStep are no longer being shipped from the manufacturer, although they may still be available from some durable medical equipment suppliers. Two manufacturers make speech boxes that plug into the data ports on these meters. Captek/Science Products (see “Resources”) has speech boxes for OneTouch Basic, and on special order can ship one for OneTouch SureStep to a person who already owns this meter. LS&S (see “Resources”) has OneTouch Basic and OneTouch Profile speech boxes, which can be sold separately from or with the meters (as long as the meters are in stock). Because of the limited availability of the OneTouch Profile and OneTouch SureStep, the following description refers to the OneTouch Basic only.

Clarity of the meter’s voice: The voice is clear, but quite rapid. It can be difficult to understand for people with hearing impairment or slow comprehension.

Available languages: English, French, and Spanish.

Volume: Can be adjusted. Does not have an earphone to allow private use in public spaces.

Repairs: The manufacturer of the meter is different from the manufacturers of the speech boxes. If a speech box malfunctions, therefore, it must be repaired by its manufacturer, not the meter company.

Size of strips: about 1.80″ x 0.60″ (for OneTouch Basic).

Ease of handling strips: Large enough to be easy to handle. However, the target area where the blood drop is applied can be damaged by touching it, so the user must avoid touching that area.

Insertion of strips: Insertion end has a notch, making it easy to identify nonvisually. Easy to insert nonvisually.

Accessible instructions: Instructions for the speech boxes are available on audiotape, but those for the meter are not. The voice reads everything that appears on the meter’s visual display, including all steps necessary for checking blood glucose level.

Coding: This meter must be coded, and the code number is not available nonvisually.

Size of blood drop: 5 microliters, a relatively large blood drop compared to more recent meters.

Placement of blood drop: The blood drop must be placed in the target area in the center of the strip. One way of ensuring that a large enough blood drop is placed in the right place is to use a Sure-Drop, a bracket that fits over the OneTouch Basic and directs a blood drop to the target area on the strip. (The Sure-Drop is available from Captek/Science Products for $24.95 plus $7.95 for shipping and handling.) Another method for finding the target area is to apply tactile markings to the removable strip holder (the plastic piece into which the strip is inserted) using 3-dimensional fabric paint or marker, and then to use these markings to help place the blood drop correctly.

Time for results to appear: 45 seconds.

Results: Read clearly, and can be repeated.

Meter’s memory size: 75 results, including dates and times.

Memory accessibility: Memory is fully accessible through the speech boxes.

Computer interface: Data from all of the OneTouch meters can be uploaded to a computer using software and cables from the manufacturer. However, the software program is not accessible with a computer screen reader.

Prodigy Audio, Prodigy Autocode, and Prodigy Voice

Size of meter: 3.80″ x 1.80″ x 1.00″ (Prodigy Audio and Prodigy Autocode) and 3.50″ x 2.00″ x 0.80″ (Prodigy Voice): small enough to be easily carried in a pocket or purse.

Cost of meter: About $30 for the Prodigy Audio and Prodigy Autocode; about $85 for the Prodigy Voice.

Meter and strip availability: The meter and strips are widely available through durable medical equipment companies and suppliers of accessible equipment for people with visual impairment.

Clarity of the meter’s voice: Clear, easy to understand.

Language availability: English or Spanish.

Volume: Can be adjusted. Only the Prodigy Voice has an earphone jack to allow private use in public spaces.

Repairs: Voice and meter are one entity, so if either malfunctioned it would be repaired by the same distributor.

Size of the strips: about 1.30″ x 0.30″.

Ease of handling strips: Easy to handle for most people. Some people with dexterity problems may have difficulty.

Insertion: The insertion end has squared corners, and the end that sticks out of the meter has rounded corners. (See “Strips: Which End Is Which?”“) The strip is easy to insert nonvisually. Although it can be inserted upside down, doing so does not turn on the meter.

Accessible instructions: No audio instructions are provided with the Prodigy Audio and Prodigy Autocode meters: The voice guides the user through the steps for monitoring, but instructions for other meter functions such as coding or changing the volume are not available in a nonvisual format. The Prodigy Voice, however, talks the user through all set-ups and steps.

Coding: Coding is required for the Prodigy Audio, and the code number is not available nonvisually. Coding is not necessary for the Prodigy Autocode or the Prodigy Voice.

Size of blood drop: 0.6 microliters.

Placement of blood drop: The strip pulls in the blood drop through a tiny opening that is easy to locate at the end of the strip. However, for a user who has very low or no vision, remembering where the blood drop is on the finger and applying it to the strip can be difficult. (See “Placing Blood Accurately on the Strip” for more details.)

Time for results to appear: 6 seconds.

Results: Voiced clearly. Only the Prodigy Voice features a repeat button that will repeat results.

Meter’s memory size: Can store up to 450 memory results, including the date and time of each reading.

Memory accessibility: Readings stored in memory are displayed only on the screen in the Prodigy Audio and Prodigy Autocode models. The Prodigy Voice model will talk users through audible averages and memory records with date and time.

Computer interface: The distributor has free software available on its Web site. Data stored in the meter memory can be uploaded to a computer via a purchased cable. However, the software program is not accessible with a computer screen reader.

Extras: The meter gives the room temperature during the startup procedure.

SensoCard Plus

Size of meter: 3.40″ x 2.00″ x 0.60″.

Cost of the meter: Not yet available in the United States as of this writing. The system is expected to cost approximately $200.

Meter and strip availability: Only available outside the United States until it receives approval from the Food and Drug Administration. The distributor is BBI Healthcare (see “Resources”).

Clarity of the voice: The voice is clear and easy to understand.

Available languages: English (with a British accent) or German.

Volume: Cannot be adjusted. Does not have an earphone to allow private use in public spaces.

Repairs: The voice and meter are one entity, so if either malfunctioned it would be repaired by the same distributor.

Size of the strips: 1.10″ x 0.30″.

Ease of handling strips: Easy to handle for most people. Some people with dexterity problems may have difficulty.

Insertion of strips: The insertion end has squared corners. The blood application end is angled with a blunt tip. (See “Strips: Which End Is Which?”) To insert nonvisually, it is important to determine which side should face up. A blind user can do this by feeling the insertion end of the strip between a thumbnail and fingernail. The side that has a ridge should face up. This is important, because if a strip is inserted upside down, the meter turns on and gives the prompt for blood application. However, it will not give a reading with an upside-down strip.

Accessible instructions: Audio instructions in American English are planned for the U.S. introduction of this meter.

Coding: Needs to be coded for each container of strips. This can be accomplished nonvisually using a code card included with the strips or visually by pressing buttons.

Size of blood drop: 0.5 microliters.

Placement of blood drop: The strip pulls in the blood drop through a tiny opening that is easy to locate at the end of the strip. However, for a user who has very low or no vision, remembering where the blood drop is on the finger and applying it to the strip can be difficult. (See “Placing Blood Accurately on the Strip” for more details.)

Time results to appear: 5 seconds.

Results: The meter reads the result clearly, and the result can be repeated if necessary.

Meter’s memory size: 500 readings with dates and times.

Memory accessibility: The memory is fully accessible through the speech function.

Computer interface: The data from the meter can be uploaded to a computer using an infrared adapter and program available from the distributor.

Just released or coming soon

Roche Diagnostics has a new talking Accu-Chek meter in development. However, as of this writing, details about the meter and its release date have not been made public.

The distributor of the Advocate meters released the Advocate Duo, a version that includes both a talking blood glucose meter and a wrist blood pressure cuff in one unit, in 2007. It also released the Advocate Redi-code that year.

The Prodigy Duo, a version that includes both a talking blood glucose meter and a wrist blood pressure cuff in one unit, was released in 2007, as was the Prodigy Voice.

Choosing wisely

Manufacturers are increasingly recognizing the need for talking blood glucose meters in today’s market. And more talking meters means more choices for people with visual impairment. Taking the time to research the options and decide which meter is best for you will make your blood glucose checks as easy as possible and can help you maintain good health for years to come.

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Also in this article:
Insurance Coverage for Talking Meters
Resources
Strips: Which End is Which?
Getting a Blood Drop onto a Strip

 

 

More articles on Tools & Technology
More articles on Eyes & Vision
More articles on Blood Glucose Monitoring

 

 


Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information provided on this Web site should not be construed as medical instruction. Consult appropriate health-care professionals before taking action based on this information.

 

 

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