Instructions:

As a person living with diabetes, we need your help. Please take a few minutes to complete the survey below to help us understand the barriers and obstacles that most often get in the way of managing your diabetes. By answering the questions below you will provide valuable feedback we will use to help medical professionals to improve diabetes care. No personally identifiable information will be requested and all information below will be kept confidential. This survey will take less than 5 minutes to complete.

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* 1. What type of diabetes do you have?

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* 2. What is your most recent A1C test result? (optional)

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* 3. Over the past 12 months, what were the top 3 barriers to managing your diabetes?

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