DigiCon

@if (isset(session()->get('doctor')['vCentralCode']))

Name *

@else

Name *

@endif

Registration No. *

Qualification *

@if (isset(session()->get('doctor')['vCentralCode']))

Speciality *

@else

Speciality *

@endif @if (isset(session()->get('doctor')['vCentralCode']))

Hospital/Clinic Address *

@else

Hospital/Clinic Address *

@endif @if (isset(session()->get('doctor')['vCentralCode']))

City *

@else

City *

@endif @if (isset(session()->get('doctor')['vCentralCode']))

State *

@else

State *

@endif

Patient’s Details

Initials *

OPD/IPD Registration No

Gender *

Male Female

Age (in Years) *

City/Town *

State *

Smoker *

Yes No

H/O Alcohol consumption *

Yes No

General Examination Findings

Pulse(per minute)

Blood Pressure: Systolic(mmHg) *

Diastolic(mmHg) *

Weight(in Kg)

Height(in cm)

Body Mass Index (BMI)(kg/m²)

Disease history, and Comorbid conditions

Type 2 Diabetes Mellitus: Years since diagnosis: *

Less than 1 yr 1 to < 2 yrs 2 to <3 yrs 3 to <4 yrs 4 to <5 yrs 5 to <10 yrs ≥10 yrs

Comorbid conditions *

Yes No

Dyslipidemia

Hypertension

Obesity

Cardiovascular Disease

Chronic Kidney Disease

Any other

Treatment details with Voglibose

Voglibose is given as a separate single pill as add on to other anti-diabetic drugs *

Yes No

Voglibose is given as dual combination (Fixed Dose Combination) with other anti-diabetic drugs *

Yes No

Voglibose is given as triple combination (Fixed Dose Combination) with other anti-diabetic drugs *

Yes No

Anti-diabetic Agents Utilization *

Drug Class and Drug	Dose/Strength (in mg unless specified)	Frequency of dosing
Biguanides
Metformin IR XR	250 500 750 1000 500 850 1000	OD BID TID
Sulfonylureas & combinations
Glimepiride	0.5 1 2 3 4	OD BID TID
Glimepiride + Metformin	0.5/500 1/500 2/500 3/500 4/500 1/850 2/850 3/850 0.5/1000 1/1000 2/1000 4/1000 3/1000	OD BID TID
Glimepiride + Metformin + Voglibose	1/500/0.2 2/500/0.2 2/500/0.3 3/500/0.3	OD BID TID
Glimepiride + Metformin + Pioglitazone	1/500/15 2/500/15	OD BID TID
Gliclazide	20 30 40 60 80	OD BID TID
Gliclazide + Metformin	30/500 40/500 60/500 80/500	OD BID TID
Gliclazide + Metformin + Voglibose	40/500/0.3 80/500/0.2 80/500/0.3	OD BID TID
Gliclazide + Metformin + Pioglitazone	30/500/15 40/500/15 60/500/15 80/500/7.5 80/500/15	OD BID TID
Glipizide	2.5 5 10	OD BID TID
Glipizide + Metformin	2.5/250 5/500	OD BID TID
Thiazolidinedione (TZD) & combinations
Pioglitazone	7.5 15 30	OD BID
Pioglitazone + Metformin	7.5/500 15/500 30/500 15/1000	OD BID TID
Alpha glucosidase inhibitors (AGIs) & combinations
Voglibose	0.2 0.3	OD BID TID
Voglibose + Metformin	0.2/500 0.3/500	OD BID TID
Meglitinides & combinations
Repaglinide	0.5 1 2	OD BID TID
Nateglinide	60 120	OD BID TID
Repaglinide + Metformin	1/500 2/500	OD BID TID
Nateglinide + Metformin	60/500 120/500	OD BID TID
Repaglinide + Voglibose	0.5/0.2 1/0.2 0.5/0.3 1/0.3	OD BID TID
Repaglinide + Metformin + Voglibose	0.5/500/0.3 1/500/0.3	OD BID TID
Dipeptidyl peptidase 4 (DPP-4) inhibitors & combinations
Vildagliptin	50 100	OD BID
Vildagliptin + Metformin	50/500 50/850 50/1000	OD BID
Sitagliptin	50 100	OD
Sitagliptin + Metformin	50/500 50/1000 100/10000	OD BID
Saxagliptin	2.5 5 10	OD
Saxagliptin + Metformin	5/500 5/1000	OD
Linagliptin	5	OD
Linagliptin + Metformin	2.5/500 5/500 2.5/850 2.5/1000	OD BID
Teneligliptin	20	OD
Teneligliptin + Metformin	20/500 20/1000	OD BID
Sodium-glucose cotransporter 2 inhibitors & combinations
Dapagliflozin	5 10	OD
Dapagliflozin + Metformin	5/500 5/1000 10/500 10/1000	OD BID
Empagliflozin	10 25	OD
Empagliflozin + Metformin	5/500 12.5/500 12.5/1000	OD BID
Canagliflozin	100 300	OD
Canagliflozin + Metformin	50/500 50/1000	OD BID
Remogliflozin	100	OD BID
Remogliflozin + Metformi	100/500 100/1000	OD BID
SGLT2i + DPP4i
Empagliflozin + Linagliptin	25/5 10/5	OD
Dapagliflozin + Saxagliptin	5/10	OD
Remogliflozin + Vildagliptin	100/50	OD BID
Remogliflozin + Teneligliptin	100/10	OD BID
Remogliflozin + Vildagliptin+ Metformin	100/50/1000	OD BID
Any Other Combination

Investigations

Glycemic Profile:

HbA1c(%) *

FBG (mg/dl)*

PPBG (mg/dl)*

Renal Profile:

Serum Creatinine (mg/dl)

e-GFR (ml/min/1.73 m²)

Blood Urea Nitrogen (mg/dl)

Lipid Profile:

Total Cholesterol (mg/dl)

LDL-C (mg/dl)

HDL-C (mg/dl)

VLDL-C (mg/dl)

Triglycerides (TG) : (mg/dl)

Apo B (mg/dl)

{{ $ActivityTypeName }}

Patient {{$iPatientNo}}

Doctor’s Details

Patient’s Details

General Examination Findings

Disease history, and Comorbid conditions

Treatment details with Voglibose

Anti-diabetic Agents Utilization *

Investigations

Glycemic Profile: