TYPE 2 DIABETES RISK ASSESSMENT FORM

Circle the right alternative and add up your points.

1. Age:

0.  Under 45 years.
2.  45–54 years.
3.  55–64 years .
4.  Over 64 years.


2. Body-mass index (See reverse of form)

0. Lower than 25 kg/m2.
1. 25–30 kg/m2
3. Higher than 30 kg/m2

3. Waist circumference measured below the ribs (usually at the level of the navel)
      MEN                                 WOMEN

0. Less than 94 cm Less than 80 cm
3. 94–102 cm 80–88 cm
4. More than 102 cm More than 88 cm

4. Do you usually have daily at least 30 minutes of physical activity at work and/or during leisure time (including normal daily activity)?

0. Yes
2. No

5. How often do you eat vegetables, fruit or berries?

0. Every day
1. Not every day

6. Have you ever taken medication for high blood pressure on regular basis?

0. No
2. Yes

7. Have you ever been found to have high blood glucose (eg in a health examination, during an illness, during pregnancy)?

0. No
5. Yes

8. Have any of the members of your immediate family or other relatives been diagnosed with diabetes (type 1 or type 2)?

0. No
3. Yes: grandparent, aunt, uncle or first cousin (but no own parent, brother, sister or child)
5. Yes: parent, brother, sister or own child

Total Risk Score
The risk of developing type 2 diabetes within 10 years is


Lower than  7    Lowestimated 1 in 100 will develop disease

7–11 Slightly elevated: estimated 1 in 25 will develop disease

12–14 Moderate: estimated 1 in 6 will develop disease

15–20 High: estimated 1 in 3 will develop disease

Higher Very high: than 20 estimated 1 in 2will develop disease


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