* 1. Please enter your basic contact info.

* 2. What type of Diabetes do you have?

* 3. Have you participated in any market research related to the treatment of diabetes in the last month?

* 4. Please indicate the medications are you currently using for the treatment of your diabetes and how long ago each treatment was initiated.

* 5. What is your age?

* 6. What is your approximate average household income?

* 7. What type of health plan do you currently have?

* 8. On a scale of 0 to 10, where 0 is not at all and 10 is it's an integral part of who I am, to what degree do you feel diabetes is a large part of your identity?

* 9. On a scale from 0 to 10, where 0 is very difficult and 10 is very easy, how difficult do you find your diabetes treatment routine?

* 10. On a scale from 0 to 10, where 0 is not at all and 10 is fully in control, how much do you feel in control over your condition?

* 11. On a scale from 0 to 10, where 0 is not at all and 10 is extremely important, how important is it for you to be in control of your blood sugar level?

* 12. How did you hear about this study?

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