Prediabete Risk Assessment

How old are you? Younger than 40 years (0 points) 40-49 years (1 point) 50-59 (2 points) 60+ (3 points) Are you a man or a woman? Man (1 point) Woman (0 points) If you are a woman, have you ever been diagnosed with gestational diabetes? Yes (1 point) No (0 points) Do you have a mother, father, sister or brother with diabetes? Yes (1 point) No (0 points) Have you ever been diagnosed with high blood pressure? Yes (1 point) No (0 points) Are you physically active? Yes (1 point) No (0 points)

What is your weight category? Pick one from the below options

1 point Any Height: 4’ 10” Weight(lbs.) 119-142 Height: 4’ 11” Weight(lbs.) 124-147 Height: 5’ 0” Weight(lbs.) 128-152 Height: 5’ 1” Weight(lbs.) 132-157 Height: 5’ 2” Weight(lbs.) 136-163 Height: 5’ 3” Weight(lbs.) 141-168 Height: 5’ 4” Weight(lbs.) 145-173 Height: 5’ 5” Weight(lbs.) 150-179 Height: 5’ 6” Weight(lbs.) 155-185 Height: 5’ 7” Weight(lbs.) 159-190 Height: 5’ 8” Weight(lbs.) 164-196 Height: 5’ 9” Weight(lbs.) 169-202 Height: 5’10” Weight(lbs.) 174-208 Height: 5’11” Weight(lbs.) 179-214 Height: 6’0” Weight(lbs.) 184-220 Height: 6’1” Weight(lbs.) 189-226 Height: 6’2” Weight(lbs.) 194-232 Height: 6’3” Weight(lbs.) 200-239 Height: 6’4” Weight(lbs.) 205-245 2 points Any Height: 4’ 10” Weight(lbs.) 143-190 Height: 4’ 11” Weight(lbs.) 148-197 Height: 5’ 0” Weight(lbs.) 153-203 Height: 5’ 1” Weight(lbs.) 158-210 Height: 5’ 2” Weight(lbs.) 164-217 Height: 5’ 3” Weight(lbs.) 169-224 Height: 5’ 4” Weight(lbs.) 174-231 Height: 5’ 5” Weight(lbs.) 180-239 Height: 5’ 6” Weight(lbs.) 186-246 Height: 5’ 7” Weight(lbs.) 191-254 Height: 5’ 8” Weight(lbs.) 197-261 Height: 5’ 9” Weight(lbs.) 203-269 Height: 5’10” Weight(lbs.) 209-277 Height: 5’11” Weight(lbs.) 215-285 Height: 6’0” Weight(lbs.) 221-293 Height: 6’1” Weight(lbs.) 227-301 Height: 6’2” Weight(lbs.) 233-310 Height: 6’3” Weight(lbs.) 240-318 Height: 6’4” Weight(lbs.) 246-327 3 points Any Height: 4’ 10” Weight(lbs.) 191+ Height: 4’ 11” Weight(lbs.) 198+ Height: 5’ 0” Weight(lbs.) 204+ Height: 5’ 1” Weight(lbs.) 211+ Height: 5’ 2” Weight(lbs.) 218+ Height: 5’ 3” Weight(lbs.) 225+ Height: 5’ 4” Weight(lbs.) 232+ Height: 5’ 5” Weight(lbs.) 240+ Height: 5’ 6” Weight(lbs.) 247+ Height: 5’ 7” Weight(lbs.) 255+ Height: 5’ 8” Weight(lbs.) 262+ Height: 5’ 9” Weight(lbs.) 270+ Height: 5’10” Weight(lbs.) 278+ Height: 5’11” Weight(lbs.) 286+ Height: 6’0” Weight(lbs.) 294+ Height: 6’1” Weight(lbs.) 302+ Height: 6’2” Weight(lbs.) 311+ Height: 6’3” Weight(lbs.) 319+ Height: 6’4” Weight(lbs.) 328+ Enter Total Score – Add point totals together that are associated with your above responses If you scored 5 or higher, can the Diabetes Prevention Program team contact you about our Diabetes Prevention Program. Yes No

If your total score is 5 or higher, you are at increased risk for having prediabetes and are at high risk for type 2 diabetes. However, only your doctor can tell for sure if you have type 2 diabetes or prediabetes, a condition in which blood sugar levels are higher than normal, but not high enough yet to be diagnosed with type 2 diabetes. Talk to your doctor to see if additional testing is needed