| Question | Response |
|---|---|
| Collection Date | |
| Did the subject take any anti-hyperglycemic agent in the last 10 years? | Yes No |
| If yes, List the Treatments received | |
| Treatment Name | |
| Start Date | |
| Ongoing? | Yes No |
| End Date | |
| Dose | |
| Dose Unit | mg ug mL g IU |
| Frequency | BID TID QID QOD QM PRN UNKNOWN |
| Route | ORAL TOPICAL SUBCUTANEOUS TRANSDERMAL INTRAOCULAR INTRAMUSCULAR RESPIRATORY (INHALATION) INTRAPERITONIAL NASAL RECTAL |