Pre-screening Questionnaire

Type 2 Diabetes with Insulin

18+ years of age

Contact Information

Please enter your legal name, a valid phone number, and a valid email address where you can be contacted.

Eligibility Questions

Please answer the following questions to determine your eligibility for this study.

Are you at at least 18 years old?
Have you been diagnosed with Type 2 diabetes?
Is your A1C in the past month between 7.0% and 10.5%?
Have you been hospitalized for congestive heart failure (CHF) in the last 2 months?
Do you have a plan to undergo a stent or balloon (revascularization) procedure?
Have you ever had chronic or acute pancreatitis?
Have you ever had gastric bypass (bariatric) surgery, or restrictive bariatric surgery (such as Lap-Band®)?