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Diabetes Clinical Trial Interest Questionnaire
We are currently seeking individuals with Type 2 diabetes (diagnosed > 6 months ago) on oral diabetes medication who are not on insulin therapy for a clinical trial of a continuous glucose monitoring system (CGM).   If you are interested, please complete the screening form below and you will be contacted if you qualify to be screened further for the study.  If selected, subjects will receive financial compensation for their time.  

If you have any questions, please email Carla at carla@endocrinemds.com
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Name *
Date of Birth *
MM
/
DD
/
YYYY
Cell Phone number *
Email address *
Have you had Type 2 Diabetes for > 6 months? *
What was your last HbA1c?            OK to skip if you cannot recall the exact number
Do you currently use a Continuous Glucose Monitor (CGM)? *
If you have used a CGM previously, has it been > 3 months since you last used it? *
How often do you check your blood sugar with a glucose meter (per day)? *
Are you currently taking any type of insulin? *
Please check the box if you are taking any of the diabetes medications in each selection (can check multiple answers) *
Required
Are you willing to make diet and lifestyle changes in response to diabetes education and blood sugar data? *
Are you pregnant? *
Are you allergic to medical grade adhesive or isopropyl alcohol (used to disinfect skin) *
Do you have any skin changes/diseases on the back of your arms (tricep area) that could interfere with placement of a CGM monitor?  Examples would be extensive psoriasis, burns, eczema, scarring, or other skin lesions. *
Do you have end-stage kidney disease and/or on any form of dialysis? *
Are you currently participating in any other clinical trials? *
Are you able to commit to attending 7 study visits (< 1 hour each) at 32255 Northwestern Highway (Tri-Atria building) in Farmington Hills over the next 6 months?   *
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