ID

19285

Beschreibung

NCT01117584 Astellas Phase 2b, Double-Blind, Randomized, Multicenter, Parallel Group, Placebo-Controlled, Dose-Finding Study to Evaluate the Efficacy, Safety and Tolerability of a 12- Week Treatment with ASP1941 in Combination with Metformin in Patients with Type 2 Diabetes Mellitus Who Have Inadequate Glycemic Control on Metformin Alone.

Stichworte

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  1. 19.12.16 19.12.16 -
  2. 28.01.17 28.01.17 -
  3. 20.09.21 20.09.21 -
Hochgeladen am

19. Dezember 2016

DOI

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Visit 2 Baseline Diab-MedSat [QS_3] NCT01117584

Englisch

Visit 2 Baseline Diab-MedSat [QS_3] NCT01117584

1 Formulare  
General Information
Beschreibung

General Information

Assessment Date
Beschreibung

Assessment Date

Datentyp

date

1. Over the past two weeks, how bothered have you been by...
Beschreibung

1. Over the past two weeks, how bothered have you been by...

a. ...the amount of home monitoring (blood sugar testing) required as a part of using your medication(s)?
Beschreibung

Home monitoring

Datentyp

text

b. ... the number of times you need to take your medication(s)?
Beschreibung

Frequency

Datentyp

text

c. ...the need to adjust the dosing (amount) of your medication(s)?
Beschreibung

Adjustment of medication

Datentyp

text

d. ...how your medication(s) interferes with with your daily life?
Beschreibung

Interference of medication with daily life

Datentyp

text

2. Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)?
Beschreibung

2. Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)?

a. Unwanted weight gain
Beschreibung

Unwanted weight gain

Datentyp

text

b. Pain or discomfort
Beschreibung

Pain or discomfort

Datentyp

text

c. Gas or bloating
Beschreibung

Gas or bloating

Datentyp

text

d. Diarrhea
Beschreibung

Diarrhea

Datentyp

text

e. Symptoms of low blood sugar (such as trembling, sweating, dizziness or blurred vision)
Beschreibung

Symptoms of low blood sugar

Datentyp

text

3. Over the past past two weeks, how dissatisfied or satisfied have you been with the ability of your diabetes medication(s) to....
Beschreibung

3. Over the past past two weeks, how dissatisfied or satisfied have you been with the ability of your diabetes medication(s) to....

a. ...keep your blood sugar levels stable (avoid highs and lows)?
Beschreibung

Blood sugar levels

Datentyp

text

b. ...help you from feeling tired and lacking energy?
Beschreibung

Help from feeling tired

Datentyp

text

4. Overall, over the past two weeks, how dissatisfied or satisfied have you been with....
Beschreibung

4. Overall, over the past two weeks, how dissatisfied or satisfied have you been with....

a. ...the ease and convenience of your diabetes medication(s)?
Beschreibung

Ease of medication

Datentyp

text

b. ...the impact of your diabetes medication(s) on your physical well-being?
Beschreibung

Impact Medication Physical Well-Being

Datentyp

text

c. ...the impact of your diabetes medication(s) on your emotional well-being?
Beschreibung

Impact Medication Emotional Well-Being

Datentyp

text

5. Thinking about your diabetes medication(s) over the past two weeks....
Beschreibung

5. Thinking about your diabetes medication(s) over the past two weeks....

a. ...how difficult has it been for you to plan your daily activities around your medication(s)?
Beschreibung

Difficult to plan daily activities

Datentyp

text

b. ...how much of a burden has it been for you to take your medication(s) as prescribed?
Beschreibung

Burden to take medication

Datentyp

text

c. ...how embarrased or awkward have you felt because of taking your medication(s)?
Beschreibung

Embarrassed to take medication

Datentyp

text

d. ...how worried have you been that your medication(s) is not helping you to slow down or prevent long-term complications?
Beschreibung

Worry Med Not Prevent Complication

Datentyp

text

6. Over the past two weeks, how often has taking your diabetes medication(s) as prescribed interfered with your ability to...
Beschreibung

6. Over the past two weeks, how often has taking your diabetes medication(s) as prescribed interfered with your ability to...

a. ...be flexible with planning meals (when you eat and what you are able to eat)?
Beschreibung

Medication interferes with meals

Datentyp

text

b. ...do your recommended physical activity or exercise?
Beschreibung

Medication Interferes with Exercise

Datentyp

text

c. ...follow your recommended diet?
Beschreibung

Medication Interferes with Diet

Datentyp

text

7. Overall, thinking about each of the aspects of your diabetes medication(s) as mentioned above, how dissatisfied or satisfied have you been with ....
Beschreibung

7. Overall, thinking about each of the aspects of your diabetes medication(s) as mentioned above, how dissatisfied or satisfied have you been with ....

...your current diabetes medication(s)?
Beschreibung

Current diabetes medication(s)

Datentyp

text

8. Overall, based on your current experiences with your diabetes medications...
Beschreibung

8. Overall, based on your current experiences with your diabetes medications...

..how interested would you be to change the type of medication(s) you take or the way you take it, if it was possible?
Beschreibung

Interest to change medication(s)

Datentyp

text

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Ähnliche Modelle

Visit 2 Baseline Diab-MedSat [QS_3] NCT01117584

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General Information
Assessment Date
Item
Assessment Date
date
Item Group
1. Over the past two weeks, how bothered have you been by...
Item
a. ...the amount of home monitoring (blood sugar testing) required as a part of using your medication(s)?
text
Home monitoring
Code List
a. ...the amount of home monitoring (blood sugar testing) required as a part of using your medication(s)?
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
Item
b. ... the number of times you need to take your medication(s)?
text
Frequency
Code List
b. ... the number of times you need to take your medication(s)?
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
Item
c. ...the need to adjust the dosing (amount) of your medication(s)?
text
Adjustment of medication
Code List
c. ...the need to adjust the dosing (amount) of your medication(s)?
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
Item
d. ...how your medication(s) interferes with with your daily life?
text
Interference of medication with daily life
Code List
d. ...how your medication(s) interferes with with your daily life?
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
Item Group
2. Over the past two weeks, how bothered have you been by any of the following due to your diabetes medication(s)?
Item
a. Unwanted weight gain
text
Unwanted weight gain
Code List
a. Unwanted weight gain
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
CL Item
Did not have this side effect (6)
Item
b. Pain or discomfort
text
Pain or discomfort
Code List
b. Pain or discomfort
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
CL Item
Did not have this side effect (6)
Item
c. Gas or bloating
text
Gas or bloating
Code List
c. Gas or bloating
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
CL Item
Did not have this side effect (6)
Item
d. Diarrhea
text
Diarrhea
Code List
d. Diarrhea
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
CL Item
Did not have this side effect (6)
Item
e. Symptoms of low blood sugar (such as trembling, sweating, dizziness or blurred vision)
text
Symptoms of low blood sugar
Code List
e. Symptoms of low blood sugar (such as trembling, sweating, dizziness or blurred vision)
CL Item
Not at all bothered (1)
CL Item
Slightly bothered (2)
CL Item
Somewhat bothered (3)
CL Item
Very bothered (4)
CL Item
Extremely bothered (5)
CL Item
Did not have this side effect (6)
Item Group
3. Over the past past two weeks, how dissatisfied or satisfied have you been with the ability of your diabetes medication(s) to....
Item
a. ...keep your blood sugar levels stable (avoid highs and lows)?
text
Blood sugar levels
Code List
a. ...keep your blood sugar levels stable (avoid highs and lows)?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
b. ...help you from feeling tired and lacking energy?
text
Help from feeling tired
Code List
b. ...help you from feeling tired and lacking energy?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item Group
4. Overall, over the past two weeks, how dissatisfied or satisfied have you been with....
Item
a. ...the ease and convenience of your diabetes medication(s)?
text
Ease of medication
Code List
a. ...the ease and convenience of your diabetes medication(s)?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
b. ...the impact of your diabetes medication(s) on your physical well-being?
text
Impact Medication Physical Well-Being
Code List
b. ...the impact of your diabetes medication(s) on your physical well-being?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item
c. ...the impact of your diabetes medication(s) on your emotional well-being?
text
Impact Medication Emotional Well-Being
Code List
c. ...the impact of your diabetes medication(s) on your emotional well-being?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item Group
5. Thinking about your diabetes medication(s) over the past two weeks....
Item
a. ...how difficult has it been for you to plan your daily activities around your medication(s)?
text
Difficult to plan daily activities
Code List
a. ...how difficult has it been for you to plan your daily activities around your medication(s)?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Somewhat (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
b. ...how much of a burden has it been for you to take your medication(s) as prescribed?
text
Burden to take medication
Code List
b. ...how much of a burden has it been for you to take your medication(s) as prescribed?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Somewhat (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
c. ...how embarrased or awkward have you felt because of taking your medication(s)?
text
Embarrassed to take medication
Code List
c. ...how embarrased or awkward have you felt because of taking your medication(s)?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Somewhat (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item
d. ...how worried have you been that your medication(s) is not helping you to slow down or prevent long-term complications?
text
Worry Med Not Prevent Complication
Code List
d. ...how worried have you been that your medication(s) is not helping you to slow down or prevent long-term complications?
CL Item
Not at all (1)
CL Item
Slightly (2)
CL Item
Somewhat (3)
CL Item
Very (4)
CL Item
Extremely (5)
Item Group
6. Over the past two weeks, how often has taking your diabetes medication(s) as prescribed interfered with your ability to...
Item
a. ...be flexible with planning meals (when you eat and what you are able to eat)?
text
Medication interferes with meals
Code List
a. ...be flexible with planning meals (when you eat and what you are able to eat)?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Sometimes (3)
CL Item
Often (4)
CL Item
All the time (5)
Item
b. ...do your recommended physical activity or exercise?
text
Medication Interferes with Exercise
Code List
b. ...do your recommended physical activity or exercise?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Sometimes (3)
CL Item
Often (4)
CL Item
All the time (5)
Item
c. ...follow your recommended diet?
text
Medication Interferes with Diet
Code List
c. ...follow your recommended diet?
CL Item
Never (1)
CL Item
Rarely (2)
CL Item
Sometimes (3)
CL Item
Often (4)
CL Item
All the time (5)
Item Group
7. Overall, thinking about each of the aspects of your diabetes medication(s) as mentioned above, how dissatisfied or satisfied have you been with ....
Item
...your current diabetes medication(s)?
text
Current diabetes medication(s)
Code List
...your current diabetes medication(s)?
CL Item
Extremely dissatisfied (1)
CL Item
Very dissatisfied (2)
CL Item
Slightly dissatisfied (3)
CL Item
Neither dissatisfied or satisfied (4)
CL Item
Slightly satisfied (5)
CL Item
Very satisfied (6)
CL Item
Extremely satisfied (7)
Item Group
8. Overall, based on your current experiences with your diabetes medications...
Item
..how interested would you be to change the type of medication(s) you take or the way you take it, if it was possible?
text
Interest to change medication(s)
Code List
..how interested would you be to change the type of medication(s) you take or the way you take it, if it was possible?
CL Item
Not at all interested  (1)
CL Item
Slightly interested (2)
CL Item
Somewhat interested (3)
CL Item
Very interested (4)
CL Item
Extremely interested (5)
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