# Diabetes Technology Accessibility in Deaf and Hard of Hearing People With Diabetes

## TL;DR

This study finds that diabetes technology is not accessible for deaf and hard of hearing people, who face significant barriers in using devices like CGMs and insulin pumps.

## Contribution

The study introduces a novel focus group approach to evaluate diabetes technology accessibility for DHH individuals and provides specific design recommendations.

## Key findings

- Nine DHH participants rated all devices as poor, with low median scores for audible, haptic, and visual alarms.
- Participants concluded that diabetes technology is not designed to be accessible for DHH individuals.
- Recommendations were provided to improve accessibility through inclusive design and universal design principles.

## Abstract

Deaf and hard of hearing (DHH) populations face higher rates of diabetes and systemic barriers accessing diabetes technology. Effective use of diabetes technology relies on sensory (e.g., visual and audible) input and interpretation by the user. This study evaluates the accessibility of continuous glucose monitoring systems (CGMs) and insulin pumps for DHH individuals.

A 2-h focus group was conducted to comprehensively evaluate the accessibility of two CGM and six insulin pumps in a sample of DHH individuals during an interactive, hands-on session. Participants used an investigator-developed 6-point Likert-like scale to score audible, haptic, and visual alarm features for each device and provided additional qualitative feedback that was captured. Observational field notes and team debriefing notes were analyzed using a thematic qualitative approach.

Nine diverse DHH participants living with diabetes consistently scored all devices as poor across each alarm feature. Median scores for audible, haptic and visual alarms for CGM were 2, 2.6, and 1.2 and for insulin pumps were 0.5, 2, and 0.7, respectively. The overall qualitative theme was that the evaluated diabetes technology devices were not designed to be accessible for DHH individuals. Participants noted that CGM and insulin pump companies fell short in providing audible, haptic, and visual alarms and provided several important recommendations.

This study highlights the importance of diabetes technology companies including the creative and diverse perspectives of DHH people in diabetes technology design and testing to optimize accessibility. This inclusive approach fosters innovation by integrating universal design principles that can ultimately enhance the experience for all users.