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Assessment of risk factors, comorbidities and treatment pattern in newly diagnosed patients of Diabetes in India (DIAB INDIA study)

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Patient's Age (years) *

Gender *

Male Female

Height (in cm) *

Weight (in Kg) *

Obesity (BMI) *

Underweight (<18.5 kg/m²) Normal BMI (18.5-22.9 kg/m²) Over weight (23.0 -24.9 kg/m²) Obese (>25 kg/m²)

Active Smoker *

Yes No

Alcohol intake *

Yes No

Tobacco use *

Yes No

Family history of diabetes *

Yes No

Physical inactivity *

Yes No

Neuropathy Nephropathy Stroke CAD Retinopathy

Clinical examination *

Systolic BP (mm Hg)
Diastolic BP (mm Hg)

Prescribed antidiabetic drug *

	Drug name	Dose (mg/day)	Frequency
Biguanides			OD BD TID
SU			OD BD TID
Alpha Glucosidase Inhibitor			OD BD TID
Thiazolidinediones			OD BD TID
DPP4-i			OD BD TID
SGLT2i			OD BD TID
Insulin/Insulin Analogues			OD BD TID
GLP 1 analogues			OD BD TID

Dietary advice *

Regular diet Intermittent Fasting Low-carb diets Weight Watchers The DASH Diet Any Other

Information not available

HbA1C (%) *

FBG (mg/dl) *

PPBG (mg/dl) *

HbA1C (%) *

FBG (mg/dl) *

PPBG (mg/dl) *

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