ID

19324

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.

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Versionen (2)
  1. 19.12.16 19.12.16 -
  2. 04.02.17 04.02.17 -
Hochgeladen am

19. Dezember 2016

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Visit 7 / Early Termination ADDQoL [QS_2] NCT01117584

Englisch

Visit 7 / Early Termination ADDQoL [QS_2] NCT01117584

1 Formulare  
General Information
Beschreibung

General Information

Assessment Date
Beschreibung

Assessment Date

Datentyp

date

In general, my Present quality of life is:
Beschreibung

Present quality of life

Datentyp

text

If I did not have diabetes, my quality of life woud be:
Beschreibung

Quality of life without diabetes

Datentyp

text

If I did not have diabetes, I would enjoy my leisure activities:
Beschreibung

Leisure activites wihtout diabetes

Datentyp

text

My leisure activities are
Beschreibung

Leisure activities

Datentyp

text

Are you currently working, looking for work or would you like to work?
Beschreibung

Work

Datentyp

boolean

If I did not have diabetes, my work life would be:
Beschreibung

Work life without diabetes

Datentyp

text

For me, having a working life is:
Beschreibung

Importance of work life

Datentyp

text

If I did not have diabetes, local or long distance journeys would be:
Beschreibung

Long distance journeys without diabetes

Datentyp

text

For me, long distance journeys are:
Beschreibung

Long distance journeys with diabetes

Datentyp

text

Did you ever go on holiday or want to go on holiday?
Beschreibung

Holidays

Datentyp

boolean

If I did not have diabetes, my holidays would be:
Beschreibung

Holidays without diabetes

Datentyp

text

For me, holidays are:
Beschreibung

Holidays with diabetes

Datentyp

text

If I did not have diabetes, physically I could do:
Beschreibung

Physical condition without diabetes

Datentyp

text

For me, how much I can do physically is:
Beschreibung

Physical condition with diabetes

Datentyp

text

Do you have any family/relatives?
Beschreibung

Family

Datentyp

boolean

If I did not have diabetes, my family life would be:
Beschreibung

Family without diabetes

Datentyp

text

My family life is
Beschreibung

Family with diabetes

Datentyp

text

If I did not have diabetes, my friendships and social life would be:
Beschreibung

Friendships and social life without diabetes

Datentyp

text

My friendships and social life are:
Beschreibung

Friendships and social life with diabetes

Datentyp

text

Do you have a close personal relationship (e.g husband/wife, partner)?
Beschreibung

Close personal relationship

Datentyp

boolean

If I did not have diabetes, my closest personal relationship would be:
Beschreibung

Close personal relationship without diabetes

Datentyp

text

For me, having a close personal relationship is:
Beschreibung

Close personal relationship with diabetes

Datentyp

text

Do you or would you like to have a sex life?
Beschreibung

Sex life

Datentyp

boolean

If I did not have diabetes, my sex life would be
Beschreibung

Sex life without diabetes

Datentyp

text

For me, having sex is:
Beschreibung

Sex life with diabetes

Datentyp

text

If I did not have diabetes, my physical appearance would be:
Beschreibung

Physical appearance without diabetes

Datentyp

text

My physical appearance is:
Beschreibung

Physical appearance with diabetes

Datentyp

text

If I did not have diabetes, my self-confidence would be:
Beschreibung

Self-confidence without diabetes

Datentyp

text

My self-confidence is:
Beschreibung

Self-confidence with diabetes

Datentyp

text

If I did not have diabetes, my motivation would be:
Beschreibung

Motivation without diabetes

Datentyp

text

My motivation is:
Beschreibung

Motivation with diabetes

Datentyp

text

If I did not have diabetes, my future would be
Beschreibung

Feelings about the future without diabetes

Datentyp

text

My feelings about the future are:
Beschreibung

Feelings about the future with diabetes

Datentyp

text

If I did not have diabetes, my financial situation would be
Beschreibung

Financial situation without diabetes

Datentyp

text

My financial situation is:
Beschreibung

Financial situation with diabetes

Datentyp

text

If I did not have diabetes, my living conditions would be
Beschreibung

Living conditions without diabetes

Datentyp

text

My living conditions are:
Beschreibung

Living conditions with diabetes

Datentyp

text

If I did not have diabetes, I would have to depend on others when I do not want to:
Beschreibung

Depending on others

Datentyp

text

For me, not having to depend on others is:
Beschreibung

Not depending on others

Datentyp

text

If I did not have diabetes, my freedom to eat as I wish would be:
Beschreibung

Freedom to eat without diabetes

Datentyp

text

My freedom to eat as I wish is:
Beschreibung

Freedom to eat with diabetes

Datentyp

text

If I did not have diabetes, my freedom to drink as I wish (e.g. fruit juice) would be:
Beschreibung

Freedom to drink without diabetes

Datentyp

text

My freedom to drink as I wish is:
Beschreibung

Freedom to drink with diabetes

Datentyp

text

Any other ways in which diabetes and its management and any complications affect your quality of life:
Beschreibung

Affect on quality of life

Datentyp

text

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Ähnliche Modelle

Visit 7 / Early Termination ADDQoL [QS_2] NCT01117584

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General Information
Assessment Date
Item
Assessment Date
date
Item
In general, my Present quality of life is:
text
Present quality of life
Code List
In general, my Present quality of life is:
CL Item
excellent (1)
CL Item
very good (2)
CL Item
good (3)
CL Item
neither good nor bad  (4)
CL Item
bad (5)
CL Item
very bad (6)
CL Item
extremely bad (7)
Item
If I did not have diabetes, my quality of life woud be:
text
Quality of life without diabetes
Code List
If I did not have diabetes, my quality of life woud be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
If I did not have diabetes, I would enjoy my leisure activities:
text
Leisure activites wihtout diabetes
Code List
If I did not have diabetes, I would enjoy my leisure activities:
CL Item
very much more  (1)
CL Item
much more (2)
CL Item
a little more  (3)
CL Item
the same  (4)
CL Item
less (5)
Item
My leisure activities are
text
My leisure activities are
Code List
My leisure activities are
CL Item
very important  (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Work
Item
Are you currently working, looking for work or would you like to work?
boolean
Item
If I did not have diabetes, my work life would be:
text
Work life without diabetes
Code List
If I did not have diabetes, my work life would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
For me, having a working life is:
text
Importance of work life
Code List
For me, having a working life is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, local or long distance journeys would be:
text
Long distance journeys without diabetes
Code List
If I did not have diabetes, local or long distance journeys would be:
CL Item
very much easier (1)
CL Item
much easier (2)
CL Item
a little easier (3)
CL Item
the same (4)
CL Item
more difficult (5)
Item
For me, long distance journeys are:
text
Long distance journeys with diabetes
Code List
For me, long distance journeys are:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Holidays
Item
Did you ever go on holiday or want to go on holiday?
boolean
Item
If I did not have diabetes, my holidays would be:
text
Holidays without diabetes
Code List
If I did not have diabetes, my holidays would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
For me, holidays are:
text
Holidays with diabetes
Code List
For me, holidays are:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, physically I could do:
text
Physical condition without diabetes
Code List
If I did not have diabetes, physically I could do:
CL Item
very much more (1)
CL Item
much more (2)
CL Item
a little more (3)
CL Item
the same (4)
CL Item
less (5)
Item
For me, how much I can do physically is:
text
Physical condition with diabetes
Code List
For me, how much I can do physically is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important  (3)
CL Item
not at all important (4)
Family
Item
Do you have any family/relatives?
boolean
Item
If I did not have diabetes, my family life would be:
text
Family without diabetes
Code List
If I did not have diabetes, my family life would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My family life is
text
Family with diabetes
Code List
My family life is
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my friendships and social life would be:
text
Friendships and social life without diabetes
Code List
If I did not have diabetes, my friendships and social life would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My friendships and social life are:
text
Freindships and social life with diabetes
Code List
My friendships and social life are:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Close personal relationship
Item
Do you have a close personal relationship (e.g husband/wife, partner)?
boolean
Item
If I did not have diabetes, my closest personal relationship would be:
text
Close personal relationship without diabetes
Code List
If I did not have diabetes, my closest personal relationship would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
For me, having a close personal relationship is:
text
Close personal relationship with diabetes
Code List
For me, having a close personal relationship is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Sex life
Item
Do you or would you like to have a sex life?
boolean
Item
If I did not have diabetes, my sex life would be
text
Sex life without diabetes
Code List
If I did not have diabetes, my sex life would be
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
For me, having sex is:
text
Sex life with diabetes
Code List
For me, having sex is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my physical appearance would be:
text
Physical appearance without diabetes
Code List
If I did not have diabetes, my physical appearance would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My physical appearance is:
text
Physical appearance with diabetes
Code List
My physical appearance is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my self-confidence would be:
text
Self-confidence without diabetes
Code List
If I did not have diabetes, my self-confidence would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My self-confidence is:
text
Self-confidence with diabetes
Code List
My self-confidence is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my motivation would be:
text
Motivation without diabetes
Code List
If I did not have diabetes, my motivation would be:
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My motivation is:
text
Motivation with diabetes
Code List
My motivation is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my future would be
text
Feelings about the future without diabetes
Code List
If I did not have diabetes, my future would be
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My feelings about the future are:
text
Feelings about the future with diabetes
Code List
My feelings about the future are:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important  (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my financial situation would be
text
Financial situation without diabetes
Code List
If I did not have diabetes, my financial situation would be
CL Item
very much bettter (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My financial situation is:
text
Financial situation with diabetes
Code List
My financial situation is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my living conditions would be
text
Living conditions without diabetes
Code List
If I did not have diabetes, my living conditions would be
CL Item
very much better (1)
CL Item
much better (2)
CL Item
a little better (3)
CL Item
the same (4)
CL Item
worse (5)
Item
My living conditions are:
text
Living conditions with diabetes
Code List
My living conditions are:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, I would have to depend on others when I do not want to:
text
Depending on others
Code List
If I did not have diabetes, I would have to depend on others when I do not want to:
CL Item
very much less (1)
CL Item
much less (2)
CL Item
a little less (3)
CL Item
the same (4)
CL Item
more (5)
Item
For me, not having to depend on others is:
text
Not depending on others
Code List
For me, not having to depend on others is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my freedom to eat as I wish would be:
text
Freedom to eat without diabetes
Code List
If I did not have diabetes, my freedom to eat as I wish would be:
CL Item
very much greater (1)
CL Item
much greater (2)
CL Item
a little greater (3)
CL Item
the same (4)
CL Item
less (5)
Item
My freedom to eat as I wish is:
text
Freedom to eat with diabetes
Code List
My freedom to eat as I wish is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Item
If I did not have diabetes, my freedom to drink as I wish (e.g. fruit juice) would be:
text
Freedom to drink without diabetes
Code List
If I did not have diabetes, my freedom to drink as I wish (e.g. fruit juice) would be:
CL Item
very much greater (1)
CL Item
much greater (2)
CL Item
a little greater (3)
CL Item
the same (4)
CL Item
less (5)
Item
My freedom to drink as I wish is:
text
Freedom to drink with diabetes
Code List
My freedom to drink as I wish is:
CL Item
very important (1)
CL Item
important (2)
CL Item
somewhat important (3)
CL Item
not at all important (4)
Affect on quality of life
Item
Any other ways in which diabetes and its management and any complications affect your quality of life:
text
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