Please answer the following
Please select your gender:
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Are you aged between 18 and 65:
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What is your BMI:
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How long have you been diagnosed with Type 2 Diabetes:
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Is your HbA1c between 6% and 10%:
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Are you currently taking Metformin:
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Has your dose of Metformin changed in the last 3 months:
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Are you taking any other medication other than Metformin to control diabetes:
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Have you had any eye problems related to diabetes requiring treatment:
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Do you smoke:
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Do you confirm you are not lactating, or pregnant and you are of non-child bearing potential:
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Have you had a serious allergic reaction like anaphylaxis to a drug or food in the past:
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Have you donated blood within the past three months:
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Have you participated in any other clinical trials in the last 3 months:
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Are you currently suffering from any of the following:
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Your details
Date of birth:
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