Neonatal and Maturity onset of youth registry india
 
   
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NATIONAL MONOGENIC DIABETES (MODY & NEONATAL DIABETES) STUDY GROUP OF INDIA

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About us
Neonatal Diabetes Registry
MODY Diabetes Registry
Congenital Hyperinsulinism (CHI)
Neonatal Registration Form
MODY Registration Form
CHI Registration Form
Consent Form
How to Send The Blood Sample
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Report
 
   
   
   
   
  Maturity Onset Diabetes of the Young (MODY)
     
  Patient Name
  Gender  
  Date Of Birth                    
  Age
  M.No  
  Contact Address
  City *  
  State *
  Pincode *
  Clinical information     
  Age at diagnosis *    
  Diagnosed during pregnancy
  Ethnic origin      
  BMI *
  Height (cms)*    
  Weight (kg)*  
  Current therapy: Is patient treated with      
  Diabetic complications if any    
  Deafness
  Renal cysts
  Proteinuria
  Renal failure
  Low renal threshold for glucose
  Most recent FBG or OGTT result
  FBG (0HR)
  2 HRS
  Date(FBG)
  Highest FBG or PPBG or 2 hr OGTT result (if available):
  Date
  GAD antibodies result  
  ICA result at diagnosis  
  C-peptide if available    
  Fasting  
  Stimulated  
  Last HbA1c (%)
  Birth weight if available (Kg)*
  if not available, was baby (approximately)
  Delivery
  Acanthosis Nigricans
  Any other details
  Any other medical problems
  Consanguinity of Parents  
  Were parents related before marriage
  Family history of diabetes:  
  Father
  Mother
  Paternal grandfather
  Paternal grandmother
  Maternal grandfather
  Maternal grandmother
  Siblings
  Children (if applicable)
  Referring Physician’s details  
  Doctor’s Name
  Qualification
  Specialization
  Mobile No
  Clinic No
  Residence No
  E-mail address
  Address to which the report should be sent
  City *
  State *
  Pincode *
           

 

























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