Monday, July 25, 2016

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies"), gaining coverage via insurance is a more laborious process for the company.

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N' Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Foracare TN'G Voice Meter: Great Option for PWD's With Visual Impairments (others, too!)

I pretty much limit my diabetes blogging these days, except when I think there's something REALLY important or unique to share, although much of what I began with now has several nonprofits and organizations to advance the issues.  Most of my diabetes-related stuff these days can be found on my Twitter feed, which is updated pretty much daily.  Still, when I need more space to share information, this blog is still where I turn.

As I last blogged a few weeks ago (see http://goo.gl/mi5nEm for my post), I was very sorry when my good friend Kitty Castellini passed away, not from diabetes or diabetes-related issues, but from a type of cancer.  Her passing is truly a loss for the broader diabetes community.  That's one reason I'm dedicating my post for today to her.  Kitty was unique for her concern about some under-served segments of out community, and I thank Kitty for that!  Incidentally, I did tell Kitty about this before she passed (or more specifically, I told her husband to share the news with her, but she was already pretty ill by that time, but I hope she was pleased to learn of it -- I think she would be).

Several years ago (in 2010), a bunch of us attended a diabetes social media conference which if I recall correctly was hosted by the pharma and medical device giant Roche (I think the one was held in Indianapolis).  One of the heated discussions that came up in that meeting was one that Kitty demanded to know more about: what the company was doing about blood glucose meters for the visually-impaired.

Mike Hoskins, yours truly, and Kitty at a  conference in 2010

Virtually all of the big manufacturers including Roche, Johnson & Johnson, Abbott, the former Bayer unit (now known as Ascensia Diabetes Care if I'm not mistaken) and others have basically abandoned that market, even though they all have a social obligation to do so in my opinion.  Kitty was the ONLY person at the event to raise that issue at that meeting, and Roche really had no good response.  Still, the visually-impaired market is a relevant and important segment, its just that the big manufacturers don't see a social obligation to serve that market I guess.  That, I think, was a good example of the kind of person Kitty was: concerned for others in the diabetes community.

Anyway, I seldom (if ever) review products because that's never been why I started blogging in the first place.  But a few weeks ago, I received an email from a company trying to compete in the blood glucose testing space, and what intrigued me about the product was not their mobile phone apps or even their meter's Bluetooth capabilities (even though those are interesting), but the meter's audio which indeed enables the visually-impaired (and others) to test their blood sugar levels by themselves and to know the results without assistance from someone with vision.

The company is called Foracare and they have U.S. headquarters in California, although they manufacture their products offshore (the product I tested was made in Taiwan, not mainland China, which is interesting itself).  Specifically, I tested the product called the Foracare TN'G (for Test N Go) Voice blood glucose meter and test strips.

The basics of the product are pretty standard, although I compared the results to both meters by Roche and Johnson & Johnson, and guess what?  The results were pretty darn close, and that presumes that the Accu-Check or OneTouch meters are any more accurate to start with, which is actually a big presumption in the first place.

Suffice to say, I felt the accuracy of this meter and strips was quite good, and compared very closely to other major brands now on the market.  More importantly, however, is the fact that test results are read aloud to the user in audio, which I told the company I thought was a relevant fact that they were not marketing previously (now, they are!).  I also gave some feedback on apps which weren't specific to theirs, but apps generally, and my take is that an app isn't useful unless it either does something that cannot be done now, or saves on the laborious data-entry process that's expected of the diabetes population.  As I understand it, the Bluetooth capability also enables the results to be transmitted to a smartphone, though I did not test that as I wasn't really interested in that product feature.

All said, I would say that this product would definitely serve the needs of the visually-impaired diabetes market very well, and the accuracy is comparable with the big brands.  Also, the product is not only a viable competitor to big-name brands, but the company seems interested in what patients are asking for, at least from what I've seen.

I did struggle a bit with the audio defaults myself (then again, my hearing isn't the greatest, so not everyone will have difficulty with this), and it IS possible to increase the volume that readings are given to users, although its buried on page 14 of the manual http://www.foracare.com/testngo/FORA-TNG-Voice-manual.pdf) so just beware of that.  I would say that a CDE or doctor's office may be able to assist patients with a legitimate need, but once I figured that out, I was pleased.  At present, the audio options are available in English and Spanish (sorry for my Canadian friends seeking a Francophone option right now).  In fact, there's a button inside the battery compartment that enables you to adjust the volume and some other settings, just push that a few times and volume comes up there) Still, this is a hugely under-served market, and having a product available today serves an unmet need that was (and still is) all but ignored by the big manufacturers.

I did ask at the Roche Social Media summit a few years ago about Bluetooth capabilities, and they suggested that does seem to be the direction that meter manufacturers seem to be moving, which wold to enable any Bluetooth-enabled meter to feature vocal applications, technically, anyway), although no company I am aware of has yet enabled this basic feature.  Frankly, that seems kind of like a lame excuse for a business decision to abandon the visually-impaired market.

However, in all, I am very comfortable recommending the Foracare TN'G Voice blood glucose meter and test strips to people with diabetes (PWD's) who are visually-impaired.  Its accuate, and the product offers something no big manufacturer does: the meter reads in audio the test results to the user.


That said, what about the meter and strips themselves?

Well, no calibration is necessary (thankfully that seems to be most all strips/meters these days, the fact that it was ever required was because manufacturers were lazy FYI), and the sample size required is tiny (0.5 microliters), plus it takes just 5 seconds or so to get a reading.  Again, most of that seems to be pretty standard these days, at least from big meter companies.  The Bluetooth app is an interesting, and potentially valuable, feature, but it does require the readings to be uploaded to the manufacturer-hosted site, and I have not investigated whether results can be downloaded into a spreadsheet or csv file, an area of ongoing frustration for PWD's.

As for insurance coverage, that seems to be an area the manufacturer is still working on.  But, I do believe that all insurance companies must offer coverage for a meter with audio if a person is visually-impaired regardless of the formulary brands under a plan (in other words, if a formulary brand doesn't have a meter the blind can use, they're obligated to cover one that blind patients can use).  How that is handled via appeals and the like, I'm not terribly familiar with, but as I

understand it, its guaranteed under Federal law (imagine an insurance company that would not cover a wheelchair for someone who could not walk ... that's the equivalent in this case, of not covering a meter and strips that will read test results for someone who is blind), but for others, I think some work remains in terms of coverage for other insurance plans, so just beware of that, and I have not investigated Medicare issues, although aside from the mail order issue that DPAC http://diabetespac.org/ is already working on (search for the campaign to "Suspend Medicare's Competitive Bidding Program For Diabetes Testing Supplies").

In short, I realize PWD's pretty much choose the formulary brands because there's a huge financial incentive to do so, but for people with visual-impairment today,  the Foracare TN'G Voice blood glucose meter and test strips is a great option.  In the future, once they get on Medicare's and various insurance company formularies, others may opt for these products, too.  They are quite accurate and good quality, too.

Thursday, June 23, 2016

A Tribute to My Dear Friend, Kitty Castellini

Between out-of-town guests staying with me for the month, and various other issues going on in my personal life, I've been busy as of late.  But I was really saddened when I learned that my good friend Kitty Castellini passed away on Sunday (June 19, 2016).  I'd met Kitty quite a few times at various diabetes conferences and meetings over the years, but we continued to speak by telephone in between.

Kitty's most widely distributed photo
from Diabetes Living Today®
Kitty, me and my spouse enjoyed the Indianapolis Indians minor league baseball game we attended in Indianapolis a few years ago, and we spent most of the time talking and laughing.  Kitty couldn't drink with her health ailments, and I chose not to drink (I think we were among the few conference attendees who weren't drinking and boozing it up).  I drink occasionally, but beer has never really been my thing, and my spouse doesn't drink, having grown up in a household with too many bad memories of an abusive and alcoholic father, so that kind of ruins the pleasure aspect of drinking.

She did a video when we attended one of the Roche conferences, which can be viewed HERE:



As you might have guessed, Kitty was a fellow person with Type 1 diabetes (having lived with it for some 50 years) perhaps best known for the weekly radio show she previously hosted known as "Diabetes Living Today®".  People need to know that the show was entirely her creation, and she really largely did everything, from identify and subsequently booking guests for the show, design and maintenance of the show's website and in 2007, she even registered for legal trademark protection of Diabetes Living Today®.  But she enjoyed her work, although she was also very protective of it.

Several years ago, her then-business relationship with her former radio co-host Dr. Joseph J. Fallon started to deteriorate.  He, in Kitty's own words, "thought he was going to be the next Dr. Oz" and he tried to claim ownership rights to "Diabetes Living Today®", which as I noted, Kitty started, owned, arranged all of the guests, came up with the agenda for the program, managed the show's website, even owned all the trademarks.  Just because she wasn't an MD didn't mean she was clueless.  When Dr. Fallon tried to claim ownership of the program (my impression was he tried to bully her), Kitty did not take the threat lying down, even though she was beginning to have her own health issues.

Happier times with Kitty and Dr. Fallon
I think they basically ended up in court (or at least she threatened to sue him with a boatload of legal documents) and because Kitty had mountains and mountains of documentation to support her rightful ownership of the program, and because Dr. Fallon lacked any of Kitty's expertise in actually running the show, he wasn't able to start his own competing show, so he somewhat unceremoniously went away without getting his own celebrity doctor show he envisioned, or much else.  Kitty joked about it after-the-fact, but it was a very stressful period for her.  Incidentally, the archives of her radio show are still available for the time-being at http://diabeteslivingtoday.com/ so I'd encourage you to listen to some of the archived shows.  I'm likely to download a few so I can still hear her voice when I'm in a nostalgic kind of mood and still want to hear her voice, but its not like talking to her on the phone was.

I mentioned that Kitty was having some health issues.  Actually, Kitty underwent a Pancreas transplant in 2004 (I don't recall that being diabetes-related even if she got a break from using insulin for a few years).  Indeed, at the time, she was the longest pancreas-alone transplant patient in the entire world, but her transplanted pancreas failed in 2013 from a virus, which meant she went back on an insulin pump.  Fortunately, she took it all in stride, and because she knew all about insulin and pumps having used them for decades, she was able to return without too much difficulty.  But then, to make matters even worse, in July 2105, Kitty found out she was no longer just dealing with diabetes and a failed pancreas transplant, she had leukemia too.  Her husband Gary was really wonderful through the entire experience, if Kitty's phone calls were any reflection.

Kitty and Gary Kleiman.  Look how long her hair was then!
I'm personally very heartbroken about Kitty and I'll miss her, but as I mentioned on Facebook, I know that now, she is in perfect health and able to look down at her many, many friends and family.

Tonight are the services for Kitty in South Jersey.  I wish I was able to go and pay my respects, but its a several hour drive and I have several guests who are in from out-of-the-country whom I can't just dump.  I will instead honor her wishes with a gift to one of both the charities she asked people remember her with.  Her obituary is HERE and she asked that memorial donations be made to the JDRF or the Cumberland County SPCA.  She continues to be remembered on social media, and the following hashtags have been generated in honor of Kitty: #DOC4Kitty and #welovekitty  - as others have mentioned, use them with love and across all social media platforms.


Thursday, May 05, 2016

Why I'm Not (Yet) Supporting #MyPumpChoice

This week, there was a bit of a brew-ha-ha over the joint announcement [see HERE for the news] from United Healthcare (the largest for-profit healthcare insurer in the U.S.) and Medtronic over insulin pump coverage, specifically that United Healthcare had chosen Medtronic to be the company's "preferred" insulin pump supplier, hence other pump and pump supply brands like Roche, Tandem or Animas would generally not be covered.  Yes, they buried it on page 7 and kind of did it on the down low which was sleazy, kind of like banks do with changes in terms to credit cards or new fees being added on your checking account.  That wasn't the best way to share the news.

Being a former Animas (now Johnson & Johnson) pump user, I guess could have been a little upset over the matter, but my reaction was much more of "so what?" instead.

Why?

Well, my perspective has been shaped by my 40 years of living with Type 1 diabetes (yes, the summer of 2016 will be my 40th diabetes anniversary, but I haven't claimed any medals that I'm probably entitled to from either Joslin or Lilly, and I'm not sure I even want to, but that's a separate discussion).  When I was diagnosed as a 7-year old child in 1976, things were a little different, but frankly, in spite of the many claims about how much different things are today, treatment today is really not different by all that much.

Relevant History

For one thing, when I was diagnosed, there were exactly 2 brands of insulin sold in the U.S., made by Eli Lilly & Company and E.R. Squibb & Sons, Inc. (better known as Squibb, now part of Bristol Myers Squibb).  Our Canadian neighbors had their own insulin manufacturer since they actually discovered insulin, and Connaught Laboratories (part of the University of Toronto until 1972), later became a crown corporation of Canada which was ultimately sold off in a privatization effort as were many other crown corporations, mainly under the leadership of then-Prime Minister Brian Mulroney.  Today, the Canadian birthplace of insulin is part of Sanofi, which has the distinction of now being home to both the Canadian and German companies originally granted licenses to make insulin from University of Toronto back in the 1920's.

As a practical matter, however, Squibb's insulin was really more of an afterthought at the time.  In the U.S. market, which was estimated to be 40-50% of the world market, Lilly held an estimated 83% share in those days.  But since the early eighties, the insulin industry has steadily consolidated, although a few companies have entered the world market, only to later be acquired by one of the three giants.  Anyway, in 1981, five companies (Novo, Nordisk, Eli Lilly, the German chemical and pharmaceutical company Hoechst [which later became Aventis, now known as Sanofi] and of course, Squibb, which would sell its insulin business and exit that market) accounted for more than 90% of the world insulin market.  I should also note that at that time, Novo Nordisk was two separate companies (both based in Denmark).  In 1989, the CEO of Nordisk Gentofte approached rival Novo Industri A/S with a proposal to merge their companies, hence they became known as Novo Nordisk in 1989.

Realize that in the late 1970's, Squibb's fortunes in insulin were somewhat plagued by various manufacturing problems, and purity was an issue.  Ultimately, they partnered with Novo (or was it Nordisk?) to solve those problems.  Novo Nordisk only entered the U.S. market in the mid-1980s with a 50/50 joint venture then known as Squibb-Novo, which Novo Nordisk later bought outright from Squibb.  Insulin pumps only emerged a few years after that, but just one company existed at the time: Minimed, a then-startup based near Los Angeles, which years later would be acquired by medical device giant Medtronic in 2001.  The reality is that Medtronic-Minimed as it was known for some time has a great deal of expertise in the insulin pump market, perhaps moreso than many of the startups in the space.

Back to Coverage Issues

Anyway, when the "preferred" announcement that United Healthcare would cover Medtronic pumps, largely because both companies had negotiated preferential pricing agreements, social media was alive with comments, mostly complaints.  As I understand it, Insulet products are excluded from this decision, hence tubeless pumps will still be covered.  My response to all of the bellyaches online was that was really no different from preferred brands of insulin or blood glucose testing supplies.  Do you have much choice in those things?  Not really.  I ask why insulin pumps are any different?

For insulin, you can still get coverage of other brands, but you'll pay a lot more for the non-preferred brands.  However, medications like insulin, including the relevant preservatives used in those products can have some very serious adverse effects, so most plans will cover them, but you'll pay a lot more, and they'll likely make it quite difficult to get coverage for those non-formulary brands, but it CAN be done.

But for testing supplies, which are a medical device, I think you're $#!t out of luck getting any coverage for non-preferred brands, folks.  The insurance company is under almost zero obligation to even cover those things, although some states impose more restrictions on insurance carriers than others (rates in those states tend to be higher than in less regulated states, including much of the South).  For coverage of continuous glucose monitoring devices, the policy is somewhat less clear.  Right now, Medtronic doesn't even make a standalone CGM, hence it appears that Dexcom is still covered, especially if patients use pen devices rather than a pump.  But all that could change in the future if Medtronic gets its act together and starts selling a standalone CGM device and sensors.  The company has hinted it could move in that direction in the future, but right now they simply aren't ready, and my sense is that won't be ready in the near future, either.

Shame on you? Really, that's the best you can do?  Come on.  They're both public companies with a fiduciary responsibility to shareholders, so you need more substance than that.



The main issue from my perspective is that while such preferred relationships are routine in today's healthcare market, many patients are getting pissed off because choices are being taken away from them.  Pumps can contain a variety of different features, and in the past, there were some very legitimate differences.  For example, when I pumped insulin a number of years ago, at that time, Minimed pumps could only deliver insulin in complete 1-unit increments, so I went with an Animas pump because it enabled 1/10th of a unit increments, which was a very big deal for me.  While this particular difference no longer exists, it did back in the early 2000's, and we might see potential new innovations, such as smarter bolusing technology, etc. so the differences aren't always cosmetic as some are implying.

Also, some prefer Omnipods over pumps with tubing (a legitimate issue for some people, think of athletes who might find it the only viable technology for them), which is why Insulet pumps are exempted from this decision.  In the end, much of the bellyaching is just complaints from people who seemingly readily switch from say Abbott test strips to J&J One Touch strips without much complaining.  But occasionally there are some significant differences in areas like accuracy at different blood sugar levels, but you basically have to read the fine-print disclosure in mice-type to see that, and accuracy details are limited in many disclosures.  But the old J&J One Touch Ultra test strips, for example, showed statistically less accuracy at hypoglycemic levels than did Roche's Accu-Check strips did at that time, yet I don't recall there being a campaign to protest that.  Why not?  I have hypoglycemia issues, so that is a big deal for people like me.

I realize that an insulin pump is with you 24/7/365 so it's very personal for many, but how is not having a choice of pump any different from not having a choice of test strips when certain brands aren't as accurate?  So far, the campaign about #mypumpchoice rings pretty hollow to me, but I'm open to a truly persuasive argument.  The only thing is that so far, I haven't heard any arguments that are very persuasive.

I'm covered by United Healthcare, and I don't feel as if I've been screwed out of anything.  It might limit my choice on pumps, and that might not sit well, but I also really don't like limits on my choice of testing supplies or insulin, and yet that's done all the time and people seem willing to accept that.  As I said, I can be convinced, but so far, the diabetes patient community hasn't even convinced me, and I'm one of you!

Author P.S.:  I'm not interested in a campaign that's about pumps exclusively.  We need to address the issues that also include insulin brands, strips and medical care more generally.  This is a broader effort, but one that needs to be addressed.  Don't ask for my help in something more narrowly focused.