Type 2 Diabetes Risk Assessment Form

Circle the right alternative and add up your points.

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

2. Waist circumference

Measured below the ribs (usually at the level of the navel)

MEN                                                             WOMEN

0 p. Less than 94 cm                             Less than 80 cm

3 p. 94–102 cm                                       80–88 cm

4 p. More than 102 cm                         More than 88 cm

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

0 p. Yes
2 p. No

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

0 p. Every day
1 p. Not every day

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

0 p. No
2 p. Yes

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

0 p. No
5 p. Yes

7. Body-mass index

(See the chart below, cross reference your height with your weight to derive your body mass)

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

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

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

Add the points together for each of your answers to calculate your total risk score.

The risk of developing type 2 diabetes within 10 years is:

Lower than 7          Low: estimated 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 2 will develop disease

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