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The Effects Of Metformin And Diabinese On Female Sex Hormone Of Type 2 Diabetes Mellitus Patients
[UNIVERSITY OF ILORIN TEACHING HOSPITAL (UITH), ILORIN, KWARA STATE] -
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APPENDIX I
QUESTIONNAIRE TO ACCESS THE ANTHROPOLOGIC AND DEMOGRAPHIC INDICES OF PATIENTS WITH TYPE TWO DIABETES MELLITUS ON ANTIDIABETIC DRUGS (METFORMIN AND DIABINESE) ATTENDING UITH ILORIN.
INTRODUCTION: I am a final year students of the Department of Medical Laboratory Science, School of Basic Medical Sciences, Kwara State University, Malete, Kwara State. This questionnaire is aimed at accessing the demographic indices of patients with type 2 diabetes mellitus on metformin and diabinese in Ilorin metropolis, Kwara State.All information provided here will be treated with utmost confidentiality and be utilized for the purpose of this study.
Please kindly help complete the questionnaire, your name is not compulsory. Tick appropriate boxes and thanks for your anticipation.
Identification number
INSTRUCTION: please tick in the appropriate box
1. Name----------------------------------------------------------- (Optional)
2. Sample Code----------------------------------------------------------
3. Age ------------------------------------------------------years
4. Occupational status----------------------------------------------------------
5. Average monthly income----------------------------------------------------------
6. State/ Town of Origin: ----------------------------------------------------------
7. Marital status: Single Married
If married, how many number of children-------------------------------------------------------
8. Level of formal Education: None Primary Secondary Tertiary
9. Do you Smoke: Yes No
If yes, name the cigarettes/per day you smoke: -----------------------------------------------
10. Do you drink Alcohol? Yes No
If yes, what brand? Beer OR Alcoholic wine --------------------------------------------------
How many bottles per day? ----------------------------------------------------------
11. Height --------------------cm
12. Weight---------------------kg
13. You have diabetes mellitus? Yes No
14. How did you know before coming to the hospital that you have diabetes mellitus -----------------------------------------------------------------------------------------------------------------
15. Age when you are diagnosed of diabetes mellitus----------------------------------------years
16. Any family history of diabetes? Yes No
17. If yes, what is the relationship between you and the family member --------------------------
18. How often do you test your blood sugar? ----------------------------------------------------------
19. Are you on antidiabetic drugs? Yes No
20. If yes which type? METFORMIN DIABINESE Others
21. How long have you been taking the pills?. --------------------------------------------------------
22. Do you have any other medical challenge(s)? Yes No
If yes, does it include any of the following? Hypertension ulcer Heart disease
Kidney disease others
23. Are you on special diet recommended by Dietician? Yes No
24. If yes, what are the types of Food, list them.1---------------------- 2-----------------------
3---------------------- 4 ----------------------------5----------------------------
25. State the combination of food you eat at a time-----------------------------------------------
Thanks for your cooperation, God bless.
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ABSRACT - [ Total Page(s): 1 ]ABSTRACT is coming soon ... Continue reading---
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ABSRACT - [ Total Page(s): 1 ]ABSTRACT is coming soon ... Continue reading---
APPENDIX A -- [Total Page(s) 1]
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APPENDIX A -- [Total Page(s) 1]
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