GuLFOMBattachment10REVISEDAppendix_L_-_Report_to_Participants_-_In-Home

Appendix L:

Report to Participants (In-Home)

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Urine Glucose Results
Name: _____________
Date: __________
(Version 0.4)

Assessment of Diabetic Symptoms (to be read by examiner):
Have you previously been diagnosed with diabetes

__ Yes

___ No

In the last month, have you experienced frequent urination or unusual thirst? ___ Yes ___ No

Results:
We tested your urine for glucose (sugar) with a chemical reagent strip (dipstick). The result is shown
below.

Urine Glucose Result:

_______________ (Negative,
Trace, Positive)

What do Urine Glucose numbers indicate?
Normal urine samples usually contain no detectable glucose (sugar). The presence of sugar in your urine
(Trace and Positive values) may indicate a risk for diabetes. The type of test we did is only a quick
screening test. It is not accurate enough to diagnose a specific disease, but it does identify people who
should have further evaluation. Even if you have been told before that you have diabetes, you should still
share a positive test result with your health care provider.
It is important to keep in mind, however, that this type of test can be falsely positive. That is, if you test
your urine again, or have a more specific test, it may be normal. Depending on your medical history or the
results of a repeated test, your health care provider will determine if any additional evaluations or
consultation are needed.
Interpretation and Advice (Please circle the appropriate cell below):

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Urine Glucose Level
Trace

Positive

(1/10th %)

(≥ ¼ %)

Of Potential
Concern

Urgent

Urgent

Yes

Of Potential
Concern

Urgent

Urgent

Yes

No

Normal

Of Potential
Concern

Urgent

No

No

Normal

Of Potential
Concern

Urgent

Prior diagnosis
of diabetes

Symptoms of
diabetes

Negative

Yes

Yes

No

Urgent:

See a health care provider within the next week to have your glucose levels
checked again

Of Potential concern: See a health care provider within the next month to have your glucose levels
checked again or sooner if symptoms should appear or worsen
Normal:

No follow-up action is required

If you have questions about your results or need additional assistance in locating health care services in
your community, please call the study center toll-free at 1-855-NIH-GULF.

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Body Mass
Index Results
Name:
____________
Date: __________
(Version 0.6)

Results:
Height: _______inches

Weight: _________ lbs

BMI: ___________

What do body mass index results indicate?
Body Mass Index (BMI) is a number calculated from a person's weight and height. BMI is a fairly
reliable indicator of body fatness for most people. BMI does not measure body fat directly, but
research has shown that BMI correlates to direct measures of body fat, BMI is used as a screening tool
to identify possible weight problems for adults.

9

Your BMI result is
BMI 30.0 and above

BMI between 25.0 to 29.9

BMI between 18.5 and
24.9

BMI < 18.5

This is
considered

You are advised to

Obese

Your BMI indicates that your weight is in
the obese range for adults of your height.
People who are obese are at higher risk
for chronic conditions such as high blood
pressure, diabetes, and high cholesterol.
You should talk to your health care
provider about this finding and any need
for additional evaluation or consultation.

Overweight

Your BMI indicates that your weight is in
the overweight range for adults of your
height. People who are overweight are at
higher risk for chronic conditions such as
high blood pressure, diabetes, and high
cholesterol. You should talk to your health
care provider about this finding and any
need for additional evaluation or
consultation.

Normal

Your BMI indicates that your weight is in
the normal range for adults of your height.
Maintaining a healthy weight may reduce
the risk of chronic diseases associated
with overweight and obesity.

Underweight

Your BMI indicates that your weight is in
the underweight category for adults of

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your height. Talk with your health care
provider to discuss these findings and any
need for additional evaluation or
consultation.

If you have questions about your results or need additional assistance in locating health care services in
your

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