Neonatal and Maturity onset of youth registry india
 
   
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MONOGENIC DIABETES REGISTRY OF INDIA

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About us
Neonatal Diabetes Registry
MODY Diabetes Registry
Congenital Hyperinsulinism (CHI)
Neonatal Registration Form
MODY Registration Form
CHI Registration Form
Consent Form
How to Send The Blood Sample
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Contact us
Report
 
   
   
   
   
  Maturity Onset Diabetes of the Young (MODY)
     
  Patient Name
  Gender  
  Date Of Birth                    
  Age
  M.No  
  Contact Address
  City  
  State
  Pincode
  Clinical information     
  Age at diagnosis *      
  Diagnosed during pregnancy
  Ethnic origin      
  BMI
  Height (cms)*      
  Weight (kg)*    
  Current therapy: Is patient treated with      
  Diabetic complications if any    
  Deafness
  Renal cysts
  Proteinuria
  Renal failure
  Low renal threshold for glucose
  Most recent FBG or OGTT result
  FBG (0HR)
  2 HRS
  Date(FBG)
  Highest FBG or PPBG or 2 hr OGTT result (if available):
  Date
  GAD antibodies result  
  ICA result at diagnosis  
  C-peptide if available    
  Fasting  
  Stimulated  
  Last HbA1c (%)
  Birth weight if available (Kg)
  if not available, was baby (approximately)
  Delivery
  Acanthosis Nigricans
  Any other details
  Any other medical problems
  Consanguinity of Parents  
  Were parents related before marriage
  Family history of diabetes:  
  Father
  Mother
  Paternal grandfather
  Paternal grandmother
  Maternal grandfather
  Maternal grandmother
  Siblings
  Children (if applicable)
  Referring Physician’s details  
  Doctor’s Name
  Qualification
  Specialization
  Mobile No  
  Clinic No  
  Residence No  
  E-mail address  
  Address to which the report should be sent
  City
  State * 
  Pincode
             

 

























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