On the next pages you will find a complete description of the Registry, its purpose, and what will happen if you decide to become a member. At the end, you can click a button to sign up.
If you agree to participate, you will then be asked to complete a very brief survey so that in the future we can invite you to participate in new projects that might be right for you. Please note that you must be 18 years or older to participate.
Your participation will help us to learn more about diabetes.
Please begin by clicking "Next"
What is the purpose of this consent? Dr. Edelman and the staff at Taking Control of Your
Diabetes (TCOYD) are collaborating with the Behavioral Diabetes Institute (BDI) to conduct a
series of research studies over the next few years. These studies are designed to lead to a better
understanding of problems experienced by people with diabetes and their families. TCOYD and
BDI want to know if you wish to learn about these new research studies when they are ready to
begin. At that time, you can decide if you wish to participate in them. By clicking below, you
will allow professional staff of TCOYD and BDI to share information about new studies with
you in the future and to ask if you might wish to participate. You have no obligation to actually
participate in any study.
What happens if I agree to be in this registry? If you agree to be in the registry, you are giving
consent for the staff of TCOYD and BDI to record information in a confidential registry that you
will provide in the brief online survey that follows this consent form. This survey will ask you
for your name, street address, phone number, gender, diagnosis, date of birth, and other diabetes-related
information, such as the type of diabetes you have and the type of medications you are
taking. This information will be kept for a maximum of three years, unless you withdraw your
permission, which you may do at any time by notifying TCOYD or BDI at the address below. If
a study occurs that needs participants who fit the information you have provided, you may be
contacted to ask if you would be interested in participating. You do not have to participate. Also,
from time to time you may be contacted to update the personal information you have provided.
What happens if I don’t agree to be in the registry? Declining to participate will have no
influence on your present or future status with respect to TCOYD. You will receive the same
information about TCOYD educational and informational programs as any other individual with
access to their website. There will be no penalty or loss of benefits to which you are otherwise
Are there any risks to my agreeing to be in the registry? Participation in the registry may
involve some loss of privacy. However, your information will be handled as confidentially as
possible. Access to your information will be limited to the research registry manager and those
who operate the registry. The information will be stored on a secure, HIPAA-protected server.
No information will be used for any purpose without your permission, and registry information
will not be shared with anyone outside TCOYD or BDI.
Are there any financial considerations? There will be no cost or payment to you for just being in the registry. However, the research studies you elect to participate in may provide a financial
payment to you.
What do I do if I have questions, now or later? You can talk with the research registry
manager about any questions, concerns or complaints you have about registry. Contact the
registry manager, Michelle DeFazio, at 858-336-8693 or firstname.lastname@example.org.
If you have questions about your rights as a research subject, to offer input, or to talk to someone other than registry staff, you can contact E&I Review Services (E&I), the review board that reviewed this project for subject rights, at 800-472-3241 (toll free) or by email at email@example.com.
You should print this page for your records.
You must scroll down to the end of the consent before continuing.
* = required field
We will send an email to this address shortly. Please click the box in this email to confirm that you received it.
Note: unlike a blood glucose meter, a CGM uses a tiny sensor placed under the skin to check glucose levels every few minutes.
The following question helps protect websites from spam and abuse; you must click the “I’m not a robot” checkbox before you can submit this form.
You have selected not to participate in the TCOYD Research Registry. If you ever decide you would like to participate, please return to this website.
Click here to go to the Behavioral Diabetes Institute home page.