Alkem

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The study to analyse usage of Glimepiride and metformin combination therapy in newly diagnosed diabetic patients (GLIMPSE study)

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Diagnosis (Newly diagnosed Type 2 diabetes Mellitus (T2DM))

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

Clinical examination *

Systolic BP (mmHg)
Diastolic BP (mmHg)

Type of preparation preferred XR/IR*

Dosage Frequency of prescribed Met + Glimepiride combination *

OD BD TDS

Reason for choosing Met + Glim therapy [You may select multiple options] *

High baseline HbA1c Low cardio-renal risk To achieve rapid reduction of glycemic parameters Cost-effective Better Compliance Excellent efficacy

Parameter	Baseline	Observation after 3 months
HbA1C (%)
Fasting Blood Glucose (mg/dl)
Post Prandial Blood Glucose (mg/dl)
Weight (Kg)

Clinician's Global Assessment of safety (Tick Appropriate) *

Excellent Good Fair Poor

Clinician's Global Assessment of Effectiveness (Tick Appropriate) *

Excellent Good Fair Poor

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