ABS 070: A Clearer Vision- Accessible Solutions for Diabetes Management

Rishika Kartik ¹ , Halis Khan Akturk ² , Michael W. Stewart ³ , Gregory P. Forlenza ⁴

¹ Brown University
² Barbara Davis Center
³ Mayo Clinic
⁴ Barbara Davis Center

Van Wickle (2025) Volume 1, ABS070

Introduction: Diabetic Retinopathy (DR) affects 93 million people worldwide. An estimated 1.07 million people are blind due to DR, and another 3.28 million people with diabetes have moderate to severe visual impairment. However, most diabetes technology and management protocols are inaccessible to blind or visually impaired (BVI) patients. Despite the development of continuous glucose monitors (CGMs) and automated insulin delivery (AID) systems, disparities persist due to insufficient tactile and auditory feedback, limited provider awareness, inadequate patient education, and exclusion of BVI participants from diabetes technology research. No clinical guidelines currently exist for managing diabetes in BVI individuals.

This narrative review summarized current developments in accessible diabetes technology and diabetes self-management education (DSME) for BVI patients. Peer-reviewed literature from 2004 to 2024 was analyzed, including clinical trials, meta analyses, reviews, surveys, case studies, and op-eds from national blindness advocacy organizations. Articles that were not in English or about other aspects of accessibility such as financial barriers were excluded.

Case reports and clinical trials showed that CGMs and AID systems are safe and effective for blind and visually impaired individuals. However, while 95% of healthcare providers recommended CGMs, only 55% knew about of accessibility features, and 20% of blind patients were advised against using insulin pumps due to perceived inability. DSME increased the probability of BVI patients performing daily glucose checks from 59.3% to 83.7%, but 86% of blind individuals remained unaware of accessible insulin delivery options. Finally, many BVI individuals reported using third-party tools such as smartphone apps, voiceover features, and real-time data-sharing to manage their diabetes. Overall, we found that diabetes technology can significantly improve healthcare outcomes for BVI patients. However, increased provider education and greater inclusion of blind individuals in the development of diabetes technology development is necessary to reduce existing disparities.

Methods: A comprehensive literature search was conducted to identify relevant studies and sources across IEEE, Cochrane, PubMed, and Google Scholar. Inclusion criteria were: (1) peer-reviewed randomized controlled trials, reviews, surveys, or case studies published between 2004 and 2024; (2) opinion articles or blogs published by the American Foundation for the Blind and the National Federation of the Blind; and (3) articles addressing diabetes education, diabetes technology, or psychosocial factors related to diabetes management. Exclusion criteria were: (1) articles not written in English; (2) articles focusing on other aspects of accessibility, such as financial barriers or policy development; and (3) abstracts or conference posters lacking complete datasets. The search aimed to capture both empirical research and perspectives from advocacy organizations and community members to provide a multifaceted understanding of diabetes management for individuals who are blind or visually impaired.

Results: New case reports and trials showed that CGMs and AID systems are safe and help lower HbA1c and hypoglycemia risk for blind and visually impaired (BVI) people. Even though 95% of providers recommend CGMs, only 55% know about accessibility features, and 20% advised against insulin pumps because of assumed inability. DSME increased daily glucose checks from 59.3% to 83.7%, but 86% of BVI patients still didn’t know about accessible insulin options. 64% reported anxiety about self-management. Tactile meters, voiceover setup help, and increasing provider education on accessibility features were the most beneficial to patients.

Discussion: This review highlights the importance of research diabetes tech outcomes in BVI patients. Despite recent evidence that CGMs and AID systems can be safe and effective for blind users, provider misconceptions and a lack of accessibility information creates barriers to access. It also highlights a need for translational research developing and evaluating accessible DSME programs, as well as more clinical trials assessing outcomes for blind individuals using technology. The ADA should work towards concrete clinical guidelines for helping patients with visual impairement with their diabetes. Finally, future studies should elaborate on the cost effectiveness of implementing accessibility features or training providers on accessibility.