Background  
Over 1.5 million adult Canadians identify as living with some degree of sight loss, with an estimated 8 million diagnosed with a visual condition that may result in sight loss. Diabetic retinopathy is a leading cause of blindness associated with diabetes in Canada with the risk of blindness being 25 times greater for individuals with diabetic retinopathy. Vision problems and blindness associated with diabetic retinopathy can be prevented or mitigated with the proper control of blood sugar and blood pressure, yet, established methods for measuring and mediating such physiological states have proved inaccessible for the visually impaired community. Insulin pumps are rarely designed with input from visually impaired individuals, making effective insulin therapy near impossible using insulin pumps. 

Aim  
Over the years, the Canadian National Institute for the Blind (CNIB) has received numerous anecdotal complaints from Canadians living with diabetes and sight loss regarding the inaccessibility of their insulin pumps. End users reported being unable to independently or safely use their insulin pump because the device must be navigated solely using visual features on a display screen. This study aimed to highlight issues currently faced by individuals with diabetes and sight loss that use insulin devices. Our research built on previous studies focusing on the accessibility of insulin devices and introduced an emphasis on first-hand testimonies from individuals with sight loss.

Method  
Data was collected from blind individuals, partially sighted individuals, or a proxy using a questionnaire, as well as through focus groups. Survey participants were recruited through CNIB’s and community partners’ networks of individuals who were blind or visually impaired, and who were also living with diabetes, as well as our networks of caregivers and healthcare providers. All qualitative responses were analyzed through categorical data analysis

Results  
We identified accessibility challenges with current pumps such as a lack of haptic feedback (i.e., vibrations), a lack of tactile feedback (i.e., buttons designed for accessibility), and a lack of sufficient audio feedback and visual feedback. Our findings clearly demonstrate that visually impaired diabetics are distressed about this accessibility issue and would greatly benefit from making insulin devices more accessible. Participants of our study reported being fearful of causing self-harm by incorrectly administering their insulin doses or by not being able to operate the device alone. Respondents also reported that they would be more independent, confident, and better able to manage their condition if they could fully utilize features of insulin pumps alone.

Discussion  
Diabetic individuals with visual impairments have long been ignored and neglected in the development of insulin devices. Our research demonstrates that current insulin devices lack accessible visual, audio, and tactile feedback mechanisms. The testimonies of neglected individuals highlighted in our research demonstrate the negative impact of insulin pump manufacturers' choices on this 'forgotten' diabetic community. We suggest that insulin device manufacturers incorporate accessibility options such as meaningful audio and tactile device feedback. In considering the needs of every population, we can facilitate a world that promotes equal status, rights, and opportunities for all individuals, especially those in marginalized communities.

References  
Canadian Survey on Disability, 2017. (2021). Retrieved 16 May 2021, from https://www150.statcan.gc.ca/n1/daily-quotidien/181128/dq181128a-eng.htm Blindness in Canada. (2020). Retrieved 24 October 2020, from https://cnib.ca/en/sight-loss-info/blindness/blindness-canada?region=on Canadian Diabetes Association. (2008). Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada . Toronto, Ont.



The Impact of the Current Accessibility of Insulin Pumps on the Lives of the Visually Impaired in Canada