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Consent Form

Title of the Study: Diabetes Information, Care and Management Study
Study Number: 2022-009
Principal Investigator: Annmarie Jackson, PhD
Co-Investigator(s): Juliet Jordan-Joseph, Pharm.D., MS, BC-ADM, CDCES
Overview of Key Information
·      Goal is to determine how people find diabetes information and care, and to uncover the challenges  they face in managing diabetes.
·      The survey will take 10 minutes in Survey Monkey.
·      You will be asked to complete a short survey.
·      We will ask you to share information about how you 
manage diabetes, and where you get information and care.
·      We will not ask for information that could be used to
       tell who you are.
·      The risk is the same as when you are doing a taking a 
       routine test or a questionnaire
·      The survey will help to create a cloud-based app that
       will improve access to a wide range of diabetes
·      While there is no immediate benefit to you for
       completing the survey, your responses will help
       to create a cloud-based App that will benefit people
       with diabetes long-term.

You have been asked to take part in a research study. This consent form describes the research study and gives you information you need to know before deciding whether to take part. You may freely choose whether or not to take part in the study; participation is completely voluntary. At the end of the form we will ask you to confirm that you voluntarily agree to be part of this study.

Why is this research study being done?
This study will help researchers to identify the challenges that people with diabetes face in finding diabetes information and care. The aim is to create an App that would improve access to a wide range of diabetes resources. We plan to recruit 37,919 people for this study.

What are you being asked to do?
You will be asked to complete a 10-minute survey in Survey Monkey. The survey will ask you to provide information about your diabetes, how you search for information, where you go for diabetes care and the types of tools you use to manage diabetes. It will also ask you to talk about the challenges you face in managing diabetes.

How will we use your private information?
In this study, we will ask you to provide information about your diabetes and how you look for information or seek care--information that you might not want other people to know. We will use your information to understand how these factors affect diabetes management.

What are the risks?
The risk is the same as taking a routine test or questionnaire

What are the benefits of being in this research study?
You will not benefit directly from this research study. However, the information you provide will help the researchers to understand the challenges that people with diabetes face in managing diabetes and will help to develop an App to provide diabetes information and care services.

What will we pay or give you in exchange for being in this study?
You will not be paid for taking part in this study.

Who can you contact if you have questions?
For questions about this study, you can email the principal investigator, Annmarie Jackson, PhD at For questions about being a research participant, please contact the chair of the Institutional Review Board ( or the Assistant Director for Research Integrity, Dr. Troy Smith, 3820 Mundy Mill Road, Oakwood, GA 30566, 678-717-3670,

What are your rights as a research study volunteer?
Your participation in this study is voluntary. If you start the survey, you may stop at anytime without a penalty and your information will be destroyed.

Question Title

* 1. Please confirm that you understand:
I have read this consent document. I have been able to ask any questions I have about the study. I have been able to tell the researcher about my concerns. The researcher has answered my questions and responded to my concerns. I believe that I understand the research study, the potential risks, and the potential benefits. By selecting "Yes" I consent to taking the survey.

Do you consent to taking the survey?

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