Diabetes Study to Test Use
of Insulin Pens by Visually Impaired

Ann Williams knows what it means to live with diabetes. The nurse diabetes educator self-diagnosed her own onset in 1991, when she began to have symptoms of the disease. After changes in her lifestyle didn’t lower her blood-sugar levels, she went to her doctor to develop a treatment plan that included diabetes medication. Eventually, Williams began a regimen of insulin, first with a syringe, then a pen and then a pump.



Managing the disease concerns Williams on a daily basis, but her interest in diabetes isn’t just personal.

She is concerned about people with diabetes who have visual impairments. Although Williams, a postdoctoral fellow at Case Western Reserve University’s Frances Payne Bolton School of Nursing, is not visually impaired herself, she knows that many people with diabetes are.

Some 3.2 million people have both diabetes and visual impairments. According to the Centers for Disease Control and Prevention, that is about one-seventh of the nearly 24 million people with diabetes in the United States. The number is greater than the total number of people who have type 1 diabetes (formerly called juvenile diabetes).

For visually impaired patients, reading the small print on a syringe and getting the right dose can be difficult or impossible. Insulin pens, popular in Europe and Asia, but less so in the United States, offer distinct advantages to patients with visual impairments. For example, a person using an insulin pen sets the dose by turning a knob that provides an audible and tactile click for each unit of insulin.

But Williams and others have noticed a disclaimer that several drug companies have placed on insulin pens. The warnings urge against use by the visually impaired, and the National Federation of the Blind has voiced concerns about the legitimacy of the disclaimer, Williams says.

“No empirical evidence exists that the blind cannot use insulin pens accurately,” she says.

Williams wants to urge insulin companies to remove the disclaimer by providing solid data about pen use by the blind. With a $6,000 grant from nursing honor society Sigma Theta Tau International and the American Association of Diabetes Educators, Williams will test the accuracy of insulin pen use by diabetes patients who are blind.

She will travel to Detroit in July for the National Federation of the Blind’s annual meeting, where she will conduct the study. According to Williams, the federation has agreed to allow her recruit 40 visually impaired people and 40 sighted people who have diabetes for her study.

“If NFB did not allow me to recruit at their meeting, it would have taken me much longer to find people and conduct the study,” she said.

Williams will examine manual dexterity skills as well as the ability to listen to digital recordings (for blind participants) or read written instructions (for sighted individuals) and then accurately administer a prescribed dose of insulin into a rubber ball, which is similar to giving oneself an injection.

William says insulin pens are easily carried in purses or pockets. When insulin is needed, the pens can deliver the drug in a less intrusive or conspicuous way in public than the syringe delivery, which requires a needle and bottle of medicine.

“It is a very discreet method to deliver the drug,” Williams says, adding that the lack of stigma of using it may encourage more people to give themselves an injection when they need it.