The RESULT Study
REmote SUpport for Low-Carbohydrate Treatment of type 2 diabetes
RESULT Eligibility Assessment
Click here to download the RESULT Participant Information Leaflet
Please answer all questions in this questionnaire.
The questions will help determine if you are eligible to take part in the RESULT study.
Please remember to click the 'SUBMIT' button when you are finished.
GP ID
Your GP ID can be found on your invitation letter in the top right corner.
Please contact the study team if you are not sure what to put here.
TV04
YH05
YH06
NW05
YH07
YH12
YH13
NW06
NW09
NW08
TV08
YH10
YH08
EA02
EA01
NW02
YH16
YH23
YH21
EA04
YH18
Date of completion
What is your age?
Do you have type 2 diabetes that was diagnosed within the past 6 years?
Yes
No
What is your height?
Units :
Feet and inches
Metres
4
5
6
feet
0
1
2
3
4
5
6
7
8
9
10
11
inches
metres
What is your weight?
Units :
Stone and pounds
Kilograms
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
stone
0
1
2
3
4
5
6
7
8
9
10
11
12
13
pounds
kg
BMI
Which ethnic background do you identify with?
(We ask this question as the body mass index ranges are different for different groups)
White
Other
Do you have access to smartphone, tablet or computer that you would be willing and able to use during this study?
(Defined: Devices with internet access and able to download an 'app' or run a web-based program)
Yes
No
Are you currently following a structured, prescribed and monitored weight loss plan?
(Defined: Like 'Slimming World' or 'Weight Watchers', or a 'soups and shakes' diet; this does not include efforts to change your diet yourself, without outside help or resources)
Yes
No
Please provide details:
Are you currently prescribed and using insulin to treat your diabetes?
Yes
No
Are you pregnant?
Yes
No
N/A
Are you planning to become pregnant within the next 12 months?
Yes
No
N/A
Are you currently breastfeeding?
Yes
No
N/A
Have you ever had weight loss surgery?
(e.g. A gastric band or gastric bypass)
Yes
No
Have you had a heart attack or a stroke in the last 3 months?
Yes
No
Are you currently receiving active treatment for cancer?
(Defined: Chemotherapy or radiotherapy - this does not include skin cancers, or people on long-term hormone treatment e.g. after breast cancer treatment)
Yes
No
Would you be willing to make changes to your diet to improve your diabetes control, lose weight or improve your general health?
Yes
No
Submit
RESULT Eligibility Assessment v1.0 19-03-2021
REC Number: 21/WM/0101, IRAS Number: 295974, Chief Investigator: Prof Paul Aveyard
