Question 1: Has your doctor or health care professional told you that you had type 1 or type 2 diabetes?

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Transcription:

DIABETES - Questions list Question 1: Has your doctor or health care professional told you that you had type 1 or type 2 diabetes? Type 1 diabetes Type 2 diabetes Neither Routing rule: ( Type 1 Diabetes->2 Type 2 Diabetes->2 Neither->19 I do not know->19 ) Question 2: At what age was this diagnosed? Question 3: Are you taking medicine for this? and I do not take medication Routing rule: ( ->4 ->5 and ->4 I do not take medication- >19 ->19 ) Question 4: Was insulin your first diabetes medicine? Diabetes V1.2 Page 1 of 7

Yes No Question 5: At what age was this first treated? Question 6: Has your doctor or health care professional told you that you had type 1 or type 2 diabetes? Type 1 diabetes Type 2 diabetes Neither Routing rule: ( Type 1 Diabetes->9 Type 2 Diabetes->13 Neither->7 I do not know->19 ) Question 7: Have you ever had gestational diabetes (ONLY during pregnancy)? Yes, I have been pregnant and have had gestational diabetes I have been pregnant but I have never had gestational diabetes I have never been pregnant Routing rule: ( Yes, I have been pregnant and have had gestational diabetes->8 I Diabetes V1.2 Page 2 of 7

have been pregnant but I have never had gestational diabetes->19 I have never been pregnant->19 ->19 ) Question 8: Did you take medicine for gestational diabetes? and I did not take medication Question 9: At what age was the type 1 diabetes diagnosed? Question 10: Are you taking medicine for the type 1 diabetes? and I do not take medication Routing rule: ( ->11 ->12 and ->11 I do not take medication->19 ->19 ) Question 11: Was insulin your first diabetes medicine? Diabetes V1.2 Page 3 of 7

Yes No Question 12: At what age was the type 1 diabetes first treated? Question 13: At what age was the type 2 diabetes diagnosed? Question 14: Are you taking medicine for the type 2 diabetes? and I do not take medication Routing rule: ( ->15 ->16 and ->15 I do not take medication->17 ->17 ) Question 15: Was insulin your first diabetes medicine? Diabetes V1.2 Page 4 of 7

Yes No Question 16: At what age was the type 2 diabetes first treated? Question 17: Did you ever have gestational diabetes during pregnancy before you were diagnosed with type 2 diabetes? Yes, I have been pregnant and have had gestational diabetes I have been pregnant but I have never had gestational diabetes I have never been pregnant Routing rule: ( Yes, I have been pregnant and have had Gestational Diabetes->18 I have been pregnant but I have never had Gestational Diabetes->19 I have never been pregnant->19 ->19 ) Question 18: Did you take medicine for gestational diabetes? and I did not take medication Diabetes V1.2 Page 5 of 7

Question 19: Does anyone in your family have type 1 diabetes? Select all that apply Father Mother Sibling Child None of the above Gender specific: None Question 20: Does anyone in your family have type 2 diabetes? Select all that apply Father Mother Sibling Child None of the above Gender specific: None Question 21: How would you rate this survey? No comment. Diabetes V1.2 Page 6 of 7

I can imagine it is useful for research. It was interesting. It could use some work. Gender specific: None Routing rule: ( END ) Diabetes V1.2 Page 7 of 7

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