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DM
Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.
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A Systems Biology Approach to Classification and Analysis of Genetic Determinants of Microvascular Complications In Type 2 Diabetes Mellitus
1
Date
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2
Name
3
Age
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4
Gender
5
Where do you live?
6
Occupation
7
Height
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8
Weight
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9
Which year were you diagnosed with Type 2 Diabetes
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10
Do you have another condition at is being managed at KNH or another hospital?
11
Do you have a confirmed diabetes complication?
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Diabetes retinopathy
Diabetes neuropathy
Diabetes nephropathy
12
What diabetes medication are you on?
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Insulin only
Oral Hypoglycemic agents
Mixed Regimen
13
Fasting Blood Sugar
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14
C- peptide
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15
HbA1c
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