CDE Detailed Report

Disease: Mitochondrial Disease
Sub-Domain: General Health History
CRF: Diabetes-Related Medical History

Displaying 1 - 50 of 75
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C20291 Urgent care clinic use hypoglycemia past year count UrgntCarClincUsHypolycmPstYrCt The count of the times the participant/subject used an after-hours or urgent care clinic for hypoglycemia in the past 12 months The count of the times the participant/subject used an after-hours or urgent care clinic for hypoglycemia in the past 12 months How many times did you/your child go to the After Hours/Urgent Care Clinic for: Hypoglycemia (low blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20270 Insulin basal total daily unit count InsulinBasalTotalDailyUnitCt The daily total of basal or long acting insulin used by the participant/subject, in units The daily total of basal or long acting insulin used by the participant/subject, in units Total daily basal insulin (or long acting) in units: Numeric Values

Enter average if not constant

Adult;Pediatric Supplemental 1.00 2015-02-12 16:35:48.0 Diabetes-Related Medical History General Health History Participant History and Family History

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0 200 units per day
C20302 Hospital admission hypoglycemia past year total day count HsptlAdmtHypoglyPstYrTtlDayCt The total duration, in days, of all of the participant's/subject's admissions to hospital for hypoglycemia in the past 12 months The total duration, in days, of all of the participant's/subject's admissions to hospital for hypoglycemia in the past 12 months # of days for all hypoglycemia admissions: Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 18:52:40.0 Diabetes-Related Medical History General Health History Participant History and Family History

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0 366 day
C20281 Emergency room use other diabetes related past year count EmrgcyRmUsOthDiabReltdPstYrCt The count of the times the participant/subject used the emergency room for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months The count of the times the participant/subject used the emergency room for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months Number of times you/your child went to the Emergency Room for: Other reasons related to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20292 Urgent care clinic use hyperglycemia past year count UrgtCarClincUsHyprglycmPstYrCt The count of the times the participant/subject used an after-hours or urgent care clinic for hyperglycemia in the past 12 months The count of the times the participant/subject used an after-hours or urgent care clinic for hyperglycemia in the past 12 months How many times did you/your child go to the After Hours/Urgent Care Clinic for: Hyperglycemia (high blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20271 Insulin bolus total daily unit count InsulinBolusTotalDailyUnitCt The daily total of bolus or short acting insulin used by the participant/subject, in units The daily total of bolus or short acting insulin used by the participant/subject, in units Total daily bolus insulin (or short acting) in units: Numeric Values

Enter average if not constant

Adult;Pediatric Supplemental 1.00 2015-02-12 16:35:48.0 Diabetes-Related Medical History General Health History Participant History and Family History

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0 200 units per day
C20303 Hospital admission hyperglycemia past year total day count HsptlAdmtHyprglyPstYrTtlDayCt The total duration, in days, of all of the participant's/subject's admissions to hospital for hyperglycemia in the past 12 months The total duration, in days, of all of the participant's/subject's admissions to hospital for hyperglycemia in the past 12 months # of days for all hyperglycemia admissions: Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 18:52:40.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

0 366 day
C20282 Emergency room use not diabetes related past year count EmrgcyRmUsNotDiabReltdPstYrCt The count of the times the participant/subject used the emergency room for reasons unrelated to diabetes in the past 12 months The count of the times the participant/subject used the emergency room for reasons unrelated to diabetes in the past 12 months Number of times you/your child went to the Emergency Room for: Reasons unrelated to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20293 Urgent care clinic use other diabetes related past year count UrgtCarClncUsOthDiabRelPstYrCt The count of the times the participant/subject used an after-hours or urgent care clinic for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months The count of the times the participant/subject used an after-hours or urgent care clinic for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months How many times did you/your child go to the After-Hours/Urgent Care Clinic: Other reasons related to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20304 Hospital admission other diabetes related past year total day count HsptlAdmtOthDiabRelPstYrTtlDCt The total duration, in days, of all of the participant's/subject's admissions to hospital for reasons related to diabetes other than hypoglycemia or hyperglycemia in the past 12 months The total duration, in days, of all of the participant's/subject's admissions to hospital for reasons related to diabetes other than hypoglycemia or hyperglycemia in the past 12 months # of days for all other diabetes related admissions: Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 18:52:40.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

0 366 day
C20272 Insulin neutral protamine hagedorn current use indicator InsulinNPHCurrUseInd The indicator of whether the participant/subject currently uses neutral protamine hagedorn (NPH) insulin The indicator of whether the participant/subject currently uses NPH insulin NPH Not used Not used Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-12 16:47:59.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20283 Diabetes 911 call past year indicator Diabetes911CallPastYearInd The indicator of whether the participant/subject has called 911 (or their local equivalent) for reasons related to their diabetes in the past 12 months The indicator of whether the participant/subject has called 911 (or their local equivalent) for reasons related to their diabetes in the past 12 months In the last 12 months, has 911 been called because of you/your child's diabetes? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20294 Urgent care clinic use not diabetes related past year count UrgtCarClncUsNotDiabRelPstYrCt The count of the times the participant/subject used an after-hours or urgent care clinic for reasons unrelated to diabetes in the past 12 months The count of the times the participant/subject used an after-hours or urgent care clinic for reasons unrelated to diabetes in the past 12 months How many times did you/your child go to the After-Hours/Urgent Care Clinic: Reasons unrelated to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20305 Hospital admission not diabetes related past year total day count HsptlAdmtNotDiabRelPstYrTtlDCt The total duration, in days, of all of the participant's/subject's admissions to hospital for reasons not related to diabetes in the past 12 months. The total duration, in days, of all of the participant's/subject's admissions to hospital for reasons not related to diabetes in the past 12 months. # of days for all non-diabetes related admissions: Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 18:52:40.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

0 366 day
C20273 Insulin premix current use indicator InsulinPremixCurrentUseInd The indicator of whether the participant/subject currently uses premix insulin The indicator of whether the participant/subject currently uses premix insulin Premix Not used Not used Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-12 16:47:59.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20284 Diabetes 911 call past year count Diabetes911CallPastYearCt The count of the times that the participant/subject called 911 (or their local equivalent) for reasons related to their diabetes in the past 12 months The count of the times that the participant/subject called 911 (or their local equivalent) for reasons related to their diabetes in the past 12 months How many times was 911 called? Numeric Values

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20295 Hospital admission past year indicator HospitalAdmissionPastYearInd The indicator of whether the participant/subject was admitted to hospital in the past 12 months The indicator of whether the participant/subject was admitted to hospital in the past 12 months In the last 12 months, have you/your child had to be admitted to the Hospital? Yes;No;Don't know Yes;No;Don't know Alphanumeric

If yes, complete the following

Adult;Pediatric Supplemental 1.00 2015-02-12 17:03:20.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20306 Medical office visit diabetes past year count MedicalOffVisitDiabtsPstYearCt The count of times that the participant/subject was seen by a health care provider at a medical office for reasons related to diabetes in the past 12 months The count of times that the participant/subject was seen by a health care provider at a medical office for reasons related to diabetes in the past 12 months How many times have you/your child seen a health care provider like a physician or nurse practitioner for an office visit for diabetes? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20274 Insulin miss dose past two week count InsulinMissDosePast2WeekCt The count of insulin doses missed by the particpant/subject in the past two weeks The count of insulin doses missed by the particpant/subject in the past two weeks Number of missed injections or pump boluses in the past 2 weeks: Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 16:53:42.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20285 Hypoglycemia 911 call past year count Hypoglycemia911CallPastYearCt The count of the times that the participant/subject called 911 (or their local equivalent) for hypoglycemia in the past 12 months The count of the times that the participant/subject called 911 (or their local equivalent) for hypoglycemia in the past 12 months Number of times 911 was called for: Hypoglycemia (low blood sugars) Numeric Values

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20296 Hospital admission past year count HospitalAdmissionPastYearCt The count of times the participant/subject was admitted to hospital in the past 12 months The count of times the participant/subject was admitted to hospital in the past 12 months How many times were you/your child admitted to the Hospital? Numeric Values

If yes, complete the following

Adult;Pediatric Supplemental 1.00 2015-02-12 17:03:20.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20307 Medical office visit not diabetes related past year count MedclOffVistNotDiabRelPastYrCt The count of times that the participant/subject was seen by a health care provider at a medical office for reasons not related to diabetes in the past 12 months The count of times that the participant/subject was seen by a health care provider at a medical office for reasons not related to diabetes in the past 12 months How many times have you/your child seen a health care provider like a physician or nurse practitioner for an office visit for other reasons? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20275 Insulin injection daily count InsulinInjectiontDailyCt The daily count (averaged if not constant) of insulin injections used by the participant/subject The daily count (averaged if not constant) of insulin injections used by the participant/subject If using injections, number of injections per day (average if not constant) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 16:57:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20286 Hyperglycemia 911 call past year count Hyperglycemia911CallPastYearCt The count of the times that the participant/subject called 911 (or their local equivalent) for hyperglycemia in the past 12 months The count of the times that the participant/subject called 911 (or their local equivalent) for hyperglycemia in the past 12 months Number of times 911 was called for: Hyperglycemia (high blood sugars) Numeric Values

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20297 Hospital admission hypoglycemia past year count HosptlAdmssnHypoglycmiaPstYrCt The count of the times the participant/subject was admitted to hospital for hypoglycemia in the past 12 months The count of the times the participant/subject was admitted to hospital for hypoglycemia in the past 12 months How many times were you/your child admitted to the Hospital for: Hypoglycemia (low blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20308 Dietician consult past year indicator DieticianConsultPastYearInd The indicator of whether the participant/subject consulted a dietician in the past 12 months The indicator of whether the participant/subject consulted a dietician in the past 12 months In the last 12 months, have you/your child seen a dietician? Yes;No;Don't know Yes;No;Don't know Alphanumeric

If Yes, complete the following:

Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20276 Insulin pen use indicator InsulinPenUseInd The indicator of whether the participant/subject uses an insulin pen. The indicator of whether the participant/subject uses an insulin pen. Do you/your child use a Pen? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-12 17:00:10.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20287 Diabetes related other 911 call past year count DiabRelatdOth911CallPastYearCt The count of the times that the participant/subject called 911 (or their local equivalent) for reasons related to their diabetes other than hypoglycemia or hyperglycemia in the past 12 months The count of the times that the participant/subject called 911 (or their local equivalent) for reasons related to their diabetes other than hypoglycemia or hyperglycemia in the past 12 months Number of times 911 was called for: Other reasons related to diabetes Numeric Values

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20298 Hospital admission hyperglycemia past year count HosptlAdmssnHyprglycmiaPstYrCt The count of the times the participant/subject was admitted to hospital for hyperglycemia in the past 12 months The count of the times the participant/subject was admitted to hospital for hyperglycemia in the past 12 months How many times were you/your child admitted to the Hospital for: Hyperglycemia (high blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20309 Dietician consult past year count DieticianConsultPastYearCt The count of times that the participant/subject consulted a dietician in the past 12 months The count of times that the participant/subject consulted a dietician in the past 12 months How many times have you/your child seen a dietician? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20277 Emergency room use past year indicator EmrgncyRoomUsePastYearInd The indicator of whether the participant/subject has used the emergency room in the past 12 months The indicator of whether the participant/subject has used the emergency room in the past 12 months In the last 12 months, have you/your child had to use the Emergency Room? Yes;No;Don't know Yes;No;Don't know Alphanumeric

If yes, complete the following

Adult;Pediatric Supplemental 1.00 2015-02-12 17:03:20.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20288 Non-diabetes related 911 call past year count NonDiabRelatd911CallPastYearCt The count of the times that the participant/subject called 911 (or their local equivalent) for reasons unrelated to their diabetes in the past 12 months The count of the times that the participant/subject called 911 (or their local equivalent) for reasons unrelated to their diabetes in the past 12 months Number of times 911 was called for: Reasons unrelated to diabetes Numeric Values

Outside of the United States, evaluate the question with respect to the direct-dial emergency number(s) available to the participant/subject.

Adult;Pediatric Supplemental 1.00 2015-02-12 17:20:26.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20266 Hypoglycemia severe loss consciousness seizure post diabetes diagnosis count HypoglySvrLOCSezrPstDiabDiagCt The count of episodes of severe hypoglycemia resulting in loss of consciousness or seizure experienced by the participant/subject in the time since they were diagnosed with diabetes The count of episodes of severe hypoglycemia resulting in loss of consciousness or seizure experienced by the participant/subject in the time since they were diagnosed with diabetes If yes, # of events Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 15:21:45.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20299 Hospital admission other diabetes related past year count HospitlAdmssnOthDiabRelPstYrCt The count of the times the participant/subject was admitted to hospital for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months The count of the times the participant/subject was admitted to hospital for diabetes-related reasons other than hypoglycemia or hyperglycemia in the past 12 months How many times were you/your child admitted to the Hospital for: Other reasons related to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20278 Emergency room use past year count EmergencyRoomUsePastYearCt The count of the times the participant/subject used the emergency room in the past 12 months. The count of the times the participant/subject used the emergency room in the past 12 months. How many times did you/your child go to the Emergency Room? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:08:23.0 Diabetes-Related Medical History General Health History Participant History and Family History

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C20289 Urgent care clinic use past year indicator UrgentCareUsePastYearInd The indicator of whether the participant/subject has used after-hours or urgent care clinic other than the emergency room in the past 12 months The indicator of whether the participant/subject has used after-hours or urgent care clinic other than the emergency room in the past 12 months In the last 12 months, have you/your child had to use an After Hours/Urgent Care Clinic (other than an Emergency Room)? Yes;No;Don't know Yes;No;Don't know Alphanumeric

If yes, complete the following

Adult;Pediatric Supplemental 1.00 2015-02-12 17:03:20.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20267 Blood glucose test daily frequency BloodGlucoseTestDailyFreq The daily frequency with which the participant/subject checks their blood glucose The daily frequency with which the participant/subject checks their blood glucose Approximately how many times a day do you/your child check his/her blood sugar? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 16:20:35.0 Diabetes-Related Medical History General Health History Participant History and Family History

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times per day
C20300 Hospital admission not diabetes related past year count HospitlAdmssnNotDiabRelPstYrCt The count of the times the participant/subject was admitted to hospital for reasons unrelated to diabetes in the past 12 months The count of the times the participant/subject was admitted to hospital for reasons unrelated to diabetes in the past 12 months How many times were you/your child admitted to the Hospital for: Other reasons unrelated to diabetes Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20279 Emergency room use hypoglycemia past year count EmrgncyRmUseHypoglycmiaPstYrCt The count of the times the participant/subject used the emergency room for hypoglycemia in the past 12 months The count of the times the participant/subject used the emergency room for hypoglycemia in the past 12 months Number of times you/your child went to the Emergency Room for: Hypoglycemia (low blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20290 Urgent care clinic use past year count UrgentCareClinicUsePastYearCt The count of the times the participant/subject used an after-hours or urgent care clinic other than the emergency room in the past 12 months. The count of the times the participant/subject used an after-hours or urgent care clinic other than the emergency room in the past 12 months. How many times did you/your child go to the After Hours/Urgent Care Clinic? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:08:23.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20268 Insulin current use indicator InsulinCurrentUseInd The indicator of whether the participant/subject currently uses insulin The indicator of whether the participant/subject currently uses insulin Are you currently on insulin? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-12 16:25:08.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20301 Medical office visit past year indicator MedicalOfficeVisitPastYearInd The indicator of whether the participant/subject was seen by a health care provider at a medical office in the past 12 months The indicator of whether the participant/subject was seen by a health care provider at a medical office in the past 12 months In the last 12 months, have you/your child seen a health care provider like a physician or nurse practitioner for an office visit? Yes;No;Don't know Yes;No;Don't know Alphanumeric

If yes, complete the following:

Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C20280 Emergency room use hyperglycemia past year count EmrgncyRmUseHyprglycmiaPstYrCt The count of the times the participant/subject used the emergency room for hyperglycemia in the past 12 months The count of the times the participant/subject used the emergency room for hyperglycemia in the past 12 months Number of times you/your child went to the Emergency Room for: Hyperglycemia (high blood sugars) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 17:11:19.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

C20258 Medication reduce blood sugar prior diagnosis name MedReduceBldSugarPriorDiagName The name of the medication to reduce blood sugar levels taken by the particpant/subject prior to diagnosis of the condition/disorder The name of the medication to reduce blood sugar levels taken by the particpant/subject prior to diagnosis of the condition/disorder Select the medication: Other;Metformin Other;Metformin Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-12 15:10:48.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C10539 Diabetes first diagnosis age value DiabetFrstDiagnosisAgeVal Value representing the age, in years, at which the participant/subject was first diagnosed with diabetes mellitus Value representing the age, in years, at which the participant/subject was first diagnosed with diabetes mellitus How old were you/your child at diagnosis? Numeric Values

For participants/subjects younger than 21 years, indicate both years and months. For those 21 and older, indicate years only.

Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

year
C20246 Birth premature week early count BirthPrematureWeekEarlyCt The count of weeks early that the participant/subject was born prematurely. The count of weeks early that the participant/subject was born prematurely. How many weeks early were you/your child born? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-12 14:06:27.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

week
C20259 Diabetic ketoacidosis emergency post diagnosis diabetes indicator DKAEmrgncyPostDiagnosDiabetInd The indicator of whether the participant/subject has experienced a diabetic ketoacidosis (DKA) episode requiring emergency or urgent treatment, in the time since their diagnosis of diabetes The indicator of whether the participant/subject has experienced a diabetic ketoacidosis (DKA) episode requiring emergency or urgent treatment, in the time since their diagnosis of diabetes Since diagnosis have you/your child ever experienced diabetic ketoacidosis (high blood sugar plus ketones, also known as DKA) diagnosed by a doctor for which he/she went to either the hospital, emergency room, or another healthcare facility? No;Yes No;Yes Alphanumeric

If yes, answer 1a-1b. If no, skip to question 2.

Adult;Pediatric Supplemental 1.00 2015-02-12 15:21:45.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16159 Family history relative age at onset value FmlyHistRltveAgeOnsetVal Age the participant's/subject's relative experienced the onset of the disease or disorder Age the participant's/subject's relative experienced the onset of the disease or disorder Age of onset Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Diabetes-Related Medical History General Health History Participant History and Family History

Free-Form Entry

year
C20249 Family history diabetes relative type FamHistDiabetesReltvTy Relationship to the participant/subject of the family member with diabetes Relationship to the participant/subject of the family member with diabetes If yes, select the relation of the family member and the approximate age of onset. Mother;Father;Grandparent;Sibling Mother;Father;Grandparent;Sibling Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

3165810
C20260 Diabetic ketoacidosis emergency past year indicator DKAEmergencyPastYearInd The indicator of whether the participant/subject has experienced a diabetic ketoacidosis (DKA) episode requiring emergency or urgent treatment in the past 12 months The indicator of whether the participant/subject has experienced a diabetic ketoacidosis (DKA) episode requiring emergency or urgent treatment in the past 12 months In the past 12 months, have you/your child ever experienced diabetic ketoacidosis (high blood sugar plus ketones, also known as DKA) diagnosed by a doctor for which he/she went to either the hospital, emergency room, or another healthcare facility? No;Yes No;Yes Alphanumeric

If yes, answer 1a-1b. If no, skip to question 2.

Adult;Pediatric Supplemental 1.00 2015-02-12 15:21:45.0 Diabetes-Related Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV