1.

ID: _______
2. Age (years): ______
3. Gender:

(1) Female

(2) Male

4. Height (centimeter): ________

5. Weight (kg): ________
6. History of Diabetes
(0) No
(1) Yes
7. Exercise (frequency per week)
(1) Non
(2) 1-2 times per week (moderate)
(3) 3 or more times per week (vigorous)