Am I at risk for having prediabetes?

What is prediabetes?

Prediabetes occurs when blood glucose levels (sugar) are higher than normal, but not high enough for a diabetes diagnosis. If no lifestyle changes occur, prediabetes can eventually become a diagnosis of type 2 diabetes.

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Your results from this survey will be sent to this email

(MM/DD/YYYY) Month, Day, Year


How old are you?*
Do you have a mother, father, sister, or brother with diabetes?*
Have you ever been diagnosed with high blood pressure?*
Are you physically active?*

*30 minutes a day for at least 5 days a week or 150 minutes per week

Are you male or female?*
If you are female, have you ever been diagnosed with gestational diabetes?

Example: for option 4'11 it means you are 4 feet and 11 inches tall. The second number is your weight

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This survey was adapted from: https://doihaveprediabetes.org/

Send results to Diabetes Prevention Program*

Please review that all questions have been answered before submitting this form