DPP Risk Assessment

1 in 3 Americans have prediabetes.

Having prediabetes means having a blood sugar (glucose) level higher than normal but not high enough to be type 2 diabetes. Many individuals do not know if they have prediabetes because they have never been given the blood test to determine it.

The YMCA of Collier County is offering a lifestyle change program, Diabetes Prevention Program (DPP), to help you prevent type 2 diabetes and other chronic conditions. The program is not for individuals who already have diabetes.

Participants must be at least 18 years old and have a Body Mass Index (BMI) of 25 or more. You must also meet at least one of the following:

Diagnosed with prediabetes by a healthcare provider.
Have a history of gestational diabetes.
Scored at least a 5 on the prediabetes risk test, below.

This is a secured form, and your information will not be shared without your permission.

How old are you?*

Younger than 40 years (0 points)40–49 years (1 point)50–59 years (2 points)60 years or older (3 points)

Are you a man or a woman?*

Woman (0 points)Man (1 point)

If you are a woman, have you ever been diagnosed with gestational diabetes?*

No (0 points)Yes (1 point)

Do you have a mother, father, sister, or brother with diabetes?*

No (0 points)Yes (1 point)

Have you ever been diagnosed with high blood pressure?*

No (0 points)Yes (1 point)

Are you physically active?*

No (1 points)Yes (0 point)

Look at the chart below. Find your height, then your weight range. Then move to the bottom of the chart to see your points. How many points does this chart say for your height and weight?*

1 Point2 Points3 Points

Your Total Risk Score:

Body Mass Index (BMI) is a measure of a person’s body weight relative to his or her height. Please use the calculator below to find out your BMI.

If you scored 5 or higher on your risk test:

This program is for you! You are likely to have prediabetes and are at high risk of developing type 2 diabetes. However, only your healthcare provider can tell you for sure if you have type 2 diabetes or prediabetes (a condition that precedes type 2 diabetes in which blood glucose levels are higher than normal). Talk to your healthcare provider to see if additional testing is needed.

If you have prediabetes:

This program is for you! The good news is that prediabetes can be reversed by making healthy daily changes, and our lifestyle change program can help.

If you have a history of gestational diabetes:

This program is for you! Women who were diagnosed with gestational diabetes during pregnancy are at greater risk of getting diagnosed with type 2 diabetes. The child you were carrying at the time, is also at greater risk of getting diagnosed with type 2 diabetes.

Complete the form below, so we can follow up with you about our lifestyle change program, which provides participants with a Lifestyle Coach and lots of group support to help prevent not only type 2 diabetes but other chronic conditions as well.

First Name*

Last Name*

E-mail*

Phone*

Are you at least 18 years old?**

YesNo

By clicking submit, you agree to receive information from the YMCA of Collier County.

Are You at Risk for Type 2 Diabetes?