CDE Detailed Report
Disease: Mitochondrial Disease
Sub-Domain: General Health History
CRF: Diabetes-Related Medical History
Displaying 1 - 50 of 75
Sub-Domain: General Health History
CRF: Diabetes-Related Medical History
Displaying 1 - 50 of 75
| CDE ID | CDE Name | Variable Name | Definition | Short Description | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
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| 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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
Free-Form Entry |
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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 |
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| 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 |
Free-Form Entry |
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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 |
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| 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 |
Free-Form Entry |
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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
Free-Form Entry |
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 |
Free-Form Entry |
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 |
Free-Form Entry |
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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 |
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| 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 |
Free-Form Entry |
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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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| 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 |
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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 | |||||||||
| 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 |
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| 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 |
Free-Form Entry |
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| 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 |
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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 | |||||||||
| 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 |
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| 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 |
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| 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 |
Free-Form Entry |
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| 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 |
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| C20252 | Family history heart problem parent type | FamHistHeartProblemParentTyp | The type of the participant's/subject's parent with a history of heart attacks, heart failure or other heart problems | The type of the participant's/subject's parent with a history of heart attacks, heart failure or other heart problems | Indicate whether you/your child's mother or father has a history of the following: Heart attacks, heart failure or other heart problems | Mother;Father;Both;Neither;Unknown | Mother;Father;Both;Neither;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-12 14:36:46.0 | Diabetes-Related Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C20263 | Diabetic ketoacidosis emergency post diagnosis diabetes count | DKAEmrgncyPostDiagnosDiabetCt | The count of diabetic ketoacidosis (DKA) episodes requiring emergency or urgent treatment experienced by the participant/subject in the time since their diagnosis of diabetes | The count of diabetic ketoacidosis (DKA) episodes requiring emergency or urgent treatment experienced by the participant/subject in the time since their diagnosis of 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 |
Free-Form Entry |
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| C19670 | Family history diagnosis age indicator | FmlyHistDiagnsisAgeInd | Indicator for whether the participant/subject knows the age of the relative when diagnosed | Indicator for whether the participant/subject knows the age of the relative when diagnosed | Age of onset: | Not known | Not known | 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 |
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| C20253 | Family history stroke parent type | FamHistStrokeParentTyp | The type of the participant's/subject's parent with a history of stroke | The type of the participant's/subject's parent with a history of stroke | Indicate whether you/your child's mother or father has a history of the following: Stroke | Mother;Father;Both;Neither;Unknown | Mother;Father;Both;Neither;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-12 14:36:46.0 | Diabetes-Related Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C20264 | Diabetic ketoacidosis emergency past year count | DKAEmeregncyPastYearCt | The count of diabetic ketoacidosis (DKA) episodes requiring emergency or urgent treatment experienced by the participant/subject in the past 12 months | The count of diabetic ketoacidosis (DKA) episodes requiring emergency or urgent treatment experienced by the participant/subject in the past 12 months | If yes, how many times? | 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 |
Free-Form Entry |
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| C20241 | Diabetes diagnosis indicator | DiabetesDiagnosisInd | The indicator of whether the participant/subject has been diagnosed with diabetes. | The indicator of whether the participant/subject has been diagnosed with diabetes. | Have you/your child been diagnosed with diabetes? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-12 13:27:31.0 | Diabetes-Related Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C20254 | Family history high cholesterol parent type | FamHistHiCholesterolParentTyp | The type of the participant's/subject's parent with a history of high cholesterol | The type of the participant's/subject's parent with a history of high cholesterol | Indicate whether you/your child's mother or father has a history of the following: High cholesterol | Mother;Father;Both;Neither;Unknown | Mother;Father;Both;Neither;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-12 14:36:46.0 | Diabetes-Related Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
