Study (NN-8577) Eligibility Questionnaire
Thank you for your interest in this clinical research study! To help us determine if you may be eligible, please answer all of the questions below. This should take less than 2 minutes. All questions require a YES or NO answer. Please answer each question honestly - there are no wrong answers. Your responses are confidential and will only be used to assess potential eligibility for this study.
First name
*
Middle name
Last name
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Are you between 18 and 75 years of age?
*
Yes
No
Have you been diagnosed with type 2 diabetes?
*
Yes
No
Are you currently taking metformin - either alone or in combination with an SGLT2 inhibitor (such as Jardiance, Farxiga, or Invokana)?
*
Yes
No
Is your most recent HbA1c (A1C) between 7.0% and 10.5%? (If you are unsure, select YES and we will check this at your screening visit.)
*
Yes
No
Is your body mass index (BMI) between 30 and 50? (If you are unsure, select YES and we will check this at your screening visit.)
*
Yes
No
Have you taken any GLP-1-based medication - including pills or injections such as Ozempic, Wegovy, Rybelsus, Mounjaro, Zepbound, Trulicity, or Foundayo - in the past 3 months?
*
Yes
No
Have you taken Januvia (sitagliptin), a sulfonylurea (such as glyburide, glimepiride, or glipizide), or insulin in the past 3 months?
*
Yes
No
Have you had bariatric surgery or had a weight loss device placed for the treatment of obesity?
*
Yes
No
Submit
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