Consent

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Study Title: Subject Recruitment Registry
Principal Investigators: Tamara K. Oser, MD; Sean M. Oser, MD, MPH
COMIRB No: 20-2497
Version Date: 11 February 2021

We would like to invite you to partner with us in efforts to improve health through discovery. We are building a community of patients and researchers who will partner together in research to advance knowledge about diabetes and managing it. Please consider joining our team and becoming part of a registry of people who are willing to be contacted about potential research opportunities. This form will give you information about the subject recruitment registry so you can make an informed decision about whether or not you would like your name and information to be included in this registry. You may contact the study team at PrimaryCareDiabetesLab@cuanschutz.edu to ask questions about anything you don't understand before deciding whether to take part.

The purpose of this registry is to house information about volunteers who are interested in learning more about future research and opportunities to partner with us to improve health through research.

If you join the screening study, you will be asked to fill out a questionnaire. This questionnaire will ask you some questions about your personal and family medical history and other health history. We will review your medical history about your diabetes and a member of our team may contact you periodically regarding current or completed research, future research, or studies for which you may qualify.

The information collected in this study will not be used in clinical care. Only the study team will have access to your identified responses and information. Your de-identified information may be used or shared with other researchers without your additional informed consent. This is a data collection study. There are no experimental study procedures.

Possible discomforts or risks include a potential loss of confidentiality. There may be risks the researchers have not thought of.

This registry is not designed to benefit you directly.

Every effort will be made to protect your privacy and confidentiality through the use of a secure web application designed to support data capture for research studies, REDCap.

You have a choice to be in this registry. You do not have to be in this study if you do not want to be.

Your participation in this registry does not guarantee you would be eligible for future studies.

Your participation in this registry is not required to participate in future studies.

The data we collect will be used for this study but may also be important for future research. Your data may be used for future research or distributed to other researchers for future study without additional consent if information that identifies you is removed from the data.

Tamara K. Oser, MD and Sean M. Oser, MD, MPH are the investigators in charge of this registry. If you have questions, you can contact them or their study team at PrimaryCareDiabetesLab@ucdenver.edu. You can call to ask questions at any time.

You may have questions about your rights as someone in this study. If you have questions, you can call COMIRB (the responsible Institutional Review Board) at (303) 724-1055.

By completing this survey, you are agreeing to participate in this screening study.

Agreement to be in this study and use my data
I have read this form and decided that I will participate in this registry. The general purposes and particulars of the registry as well as possible hazards and inconveniences have been explained to my satisfaction. I understand that I can withdraw at any time. I consent to the use of electronic consent.

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Name of study team member recording consent

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Describe the consent attained (e.g. consent to contact for future research received during consent for another study).

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