1 How old are you? | |
Less than 40 years ........................... | 0 |
40–49 years ...................................... | 1 |
50–59 years ...................................... | 2 |
60 years or older .............................. | 3 |
2. Are you a man or a woman? | |
Man ................................................... | 1 |
Woman .............................................. | 0 |
3. If you are a woman, have you ever been diagnosed with gestational diabetes? | |
Yes .................................................... | 1 |
No ..................................................... | 0 |
4. Do you have a mother, father, sister, or brother with diabetes? | |
Yes .................................................... | 1 |
No ..................................................... | 0 |
5. Have you ever been diagnosed with high blood pressure? | |
Yes .................................................... | 1 |
No ..................................................... | 0 |
6. Are you physically active? | |
Yes .................................................... | 1 |
No ..................................................... | 0 |
7. What is your weight status? | |
(see chart at right) | |
ADD UP YOUR SCORE | |