C2
History of giving birth to a baby ≥ 4 kg (for women) | Yes No | 1 2 | | |
D3 | Prehistoric diagnose pregnancy (for women) | Yes No | 1 2 | |
D4.1 | History of smoking Menopause for women | Yes No …………… year old | 1 2 | ………bags/year |
D4.2 | Time of diagnosis | // | ||
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Some Risk Factors Associated with Cardiovascular Disease in Patients with Type 2 Diabetes

D2
D4.4
Physical activity Status malnutrition | 1. High level activity 2. Moderate level activity 3. Low level activity 1. Yes 2. No | |||
D5 | Prehistoric or currently have lipid disorders | Yes No | 1 2 | |
D6 | History of hypertension | Yes No | 1 2 | |
D7 | History of other diseases | Yes No | 1 2 | |
D4.3
5. Asthma/COPD | 8. Chronic kidney disease 6. Kidney failure | |
2. Accident | 9. Knee osteoarthritis | |
cerebral circuit | 6. Dilution | |
3. Stuffing | bone | 10. Other |
myocardial blood | 7. Pathology | |
4. Accident | thyroid | |
cerebral circuit |
1. Angina
D8 | Use of drugs: Diabetes medication | |
1.Metformin …………….tablets/day | 4. DP inhibition | |
2.Sunfunylurea……………tablets/day | 5.SGLT2… | |
3.Alphaglucosidase……………….tablets/day | ||
6.Injected insulin: yes/no, Total dose ……………..unit/day One stitch Two stitches Three stitches | ||
Blood pressure medication | ||
1.Calcium channel blocker…….tablet/day | 4. Beta blockers………. | |
2. ACE inhibitors: …. ……….............tablets/day | 5.Diuretic……day | |
3. AT1 receptor blocker………tablet/day | 6.Other…………..tablets | |
Lipid medication | ||
1.Simvastatin …..…tablets/day | 4. Artervastatin …… day | |
2. Fenofibrate ……...tablets/day | 5. Rosuvastatin… vi | |
3.Ezetimide………………tablets/day | ||
Eye examination: for patients participating in exercise | ||
P4………
…………
n/day
…….tablet/
/ day
……tablets/day
Medical record code………………………Patient code………………………
E. CLINICAL AND PARACLINICAL INDICATORS
Index
0 months | After 12 months | |
Height (m) | ||
Weight (kg) | ||
Waist (cm) |
Hip circumference (cm)
Resting blood pressure (mmHg) | ||
Heart rate | ||
Hand grip force P (kg) L1 L2 |
L2
6 m walking time |
Hand grip force T (kg) L1
Index
0 months | After 3 month | After 6 month | After 9 month | After 12 months | |
Glucose (mmol/l) |
Triglycerides (mmol/l) | |||||
Cholesterol lTP (mmol/l) | |||||
LDL C (mmol/l) |





