Alkem

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GLIMPSE 2

The retrospective study to analyse usage of fixed dose combination of Glimepiride, metformin and voglibose diabetic patients

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Diagnosis (Type 2 diabetes Mellitus (T2DM))

Parameter

Patient's Age (years) *

Gender *

Male Female

Weight(in kg.) *

Risk factors

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)

Prescribed strength of FDC of MET + Glimepiride + voglibose *

Glimepiride 0.5 mg Metformin 500 mg voglibose 0.2 mg Glimepiride 1 mg Metformin 500 mg voglibose 0.2 mg Glimepiride 1 mg Metformin 1000 mg voglibose 0.2 mg Glimepiride 1 mg Metformin 500 mg voglibose 0.3 mg Glimepiride 2 mg Metformin 500 mg voglibose 0.2 mg Glimepiride 2 mg Metformin 500 mg voglibose 0.3 mg Glimepiride 2 mg Metformin 1000 mg voglibose 0.2 mg Any other

Dosage Frequency of prescribed Met + Glimepiride+ Voglibose combination *

OD BD TDS

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

High baseline HbA1c Postprandial hyperglycemia Cost-effective Better Compliance Excellent efficacy

Investigations *

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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