Trent LPS17007 Pre-Screen

Pre-screening form for A 24-Week, Multicenter, Randomized, Open-Label, Parallel-Group Trial Comparing the Efficacy and Safety of Insulin Glargine 300 U/mL (Gla-300) and Insulin Degludec 100 U/mL (IDeg-100) in Insulin-Naïve People with Type 2 Diabetes Mellitus and Renal Impairment:

Trent LPS17007
Full Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email
example@example.com
Phone Number*
Please enter a valid phone number.
Have you been diagnosed with Type 2 Diabetes Mellitus for at least 1 year?*

YesNo
When were your most recent blood lab results taken?*

Within 1 month ago.Within 3 months ago.Within 6 months ago.More than 6 months ago.
What percent was your last HbA1c level at?*
Check your last lab results.
What are your eGFR(estimated glomerular filtration rate) levels at?*
Check your last lab results. (You may just enter the number without the units.)
Are you insulin-Naïve? (Meaning you have never been prescribed an insulin injection/insulin analog on a regular basis).*
Form of contact
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Pre-screening form for A 24-Week, Multicenter, Randomized, Open-Label, Parallel-Group Trial Comparing the Efficacy and Safety of Insulin Glargine 300 U/mL (Gla-300) and Insulin Degludec 100 U/mL (IDeg-100) in Insulin-Naïve People with Type 2 Diabetes Mellitus and Renal Impairment: