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Screening

How would you describe your patient's attitude toward food?
Fearful - often scared of eating certain foods/food groups, worried about how food will affect their weight or diabetes
Chaotic - their intake is all over the place in terms of type, amount, or frequency of eating
Uninformed - unsure about what to eat, often counting carbs incorrectly, limited amount of knowledge about food/nutrition
Confident - they know what they're doing, aware of how food affects their bodies
How often does your patient take their medication as prescribed (including taking enough insulin)
Always
Usually
Sometimes
Rarely
Never
My patient takes medication less than needed due to lack of accessibility to affordable care
If your patient has a high A1c, what's your best guess as to why?
New diagnosis
Burnout
Lack of education
They aren't taking their medication as prescribed
Eating disorder behaviors
Chaotic eating and/or binge eating
N/A (A1c in range)
How would you describe your patient's weight trends?
Recent intentional weight loss
Recent unintentional weight loss
Recent intentional weight gain
Recent unintentional weight gain
Patient's weight frequently cycles up and down
No changes
How does your patient feel about their weight?
Frustrated
Anxious/fearful
Content
I'm not sure
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