Section B: Sources of Diabetes Care

Section B: Sources of Diabetes Care Module of 2003 Mail Survey On Diabetes

Label Type Description
B1 Question Who currently provides your main diabetes health care? (Mark one.)
B2 Question How long have you been seeing the health care provider who takes care of your diabetes? (Mark one.)
B3 Question When was your last Hemoglobin A1c test? (This is also known as glycohemoglobin or glycosylated hemoglobin, a test that measures your average blood sugar level over the past two or three months.) (Mark one.)
B4 Question What was the value of your Hemoglobin A1c the last time your health care provider checked it? (Mark one.)
B5 Question Do you have a goal or target for what you would like your Hemoglobin A1c level to be at or below?
B6 Question What is your goal for your Hemoglobin A1c level?
B7 Question My last urine analysis was: (Mark one.) (Gave a urine sample to be tested by the health care provider, clinic, or laboratory)
B8 Question In the past 12 months, how many times have you stayed overnight in the hospital? (Mark one.)
B9A Question In the past 12 months, how many times did you: (Mark one answer for each line.) See the doctor or nurse who takes care of your diabetes
B9B Question See any other medical doctor or nurse in a doctor's office or medical clinic
B9C Question See any doctor or nurse in an emergency room
B10 Question When was the last time that you had an eye exam during which the doctor put drops in your eyes that made your pupils large? (You may have been unable to see enough to drive or had to wear dark glasses afterward.) (Mark one.)
B11 Question Have you ever had diabetes education outside your usual doctor or nurse visits, either individually by a diabetes educator or in a special class? (qxb11)
B12 Question If you have not had diabetes education, why not? (Mark all that apply.)
B13 Question Did you ever see a dietitian to learn about a diabetic meal plan or diet?
B14 Question If you have never seen a dietitian, why not? (Mark all that apply)
B15A Question How often do you get any diabetes information from the following sources? Television
B15B Question How often do you get any diabetes information from the following sources? Internet
B15C Question How often do you get any diabetes information from the following sources? Newspapers or magazines
B15D Question How often do you get any diabetes information from the following sources? Books
B15E Question How often do you get any diabetes information from the following sources? Friends
B16 Question How often do you bring up with your doctor any information you've heard or seen that might affect your treatment? (Mark one.)