| Your Score |  | Your Score | |||
---|---|---|---|---|---|---|
1. Your age group? | Â | 6. Are you currently taking medication for high blood pressure? | Â | |||
 Under 35 years | 0 points |  |  No | 0 points |  | |
 35 – 44 years | 2 points |  |  Yes | 2 points | ___ | |
 45 – 54 years | 4 points |  |  |  |  | |
 55 – 64 years | 6 points |  |  |  |  | |
 65 years or over | 8 points | ___ |  |  |  | |
2. Your gender? | 7. Do you currently smoke cigarettes or any other tobacco products on a daily basis? | Â | ||||
 Female | 0 points |  |  No | 0 points |  | |
 Male | 3 points | ___ |  Yes | 2 points | ___ | |
3. Ethnicity/Country of birth: | Â | Â | 8. How often do you eat vegetables or fruit? | Â | ||
3a. Are you of Aboriginal, Torres Strait Islander, Pacific Islander or Maori descent? |  |  |  Everyday | 0 points |  | |
 No | 0 points |  |  Not everyday | 1 point | ___ | |
 Yes | 2 points | ___ | 9. On average, would you say you do at least 2.5 hours of physical activity per week (for example, 30 minutes a day on 5 or more days a week)? |  | ||
3b. Where were you born? |  |  |  Yes | 0 points |  | |
 Asia (including the Indian sub-continent), Middle East, North Africa, Southern Europe | 2 points |  |  No | 2 points | ___ | |
 Other | 0 points | ___ |  |  |  | |
4. Have either of your parents, or any of your brothers or sisters been diagnosed with diabetes (type 1 or type 2)? | Â | Â | 10. Your waist measurement taken below the ribs (usually at the level of the navel)? | Â | ||
 No | 0 points |  |  For those of Asian or Aboriginal or Torres Strait Islander descent: |  | ||
 Yes | 3 points | ___ |  Men | Women |  |  |
5. Have you ever been found to have high blood glucose (sugar) (for example, in a health examination, during an illness, during pregnancy)? |  |  |  Less than 90 cm | Less than 80 cm | 0 points |  |
 No | 0 points |  |  90 – 100 cm | 80 – 90 cm | 4 points |  |
 Yes | 6 points | ___ |  More than 100 cm | More than 90 cm | 7 points |  |
 |  |  |  For all others: |  |  |  |
 |  |  |  Men | Women |  |  |
 |  |  |  Less than 102 cm | Less than 88 cm | 0 points |  |
 |  |  |  102 – 110 cm | 88 – 100 cm | 4 points |  |
 |  |  |  More than 110 cm | More than 100 cm | 7 points | ___ |
 | Subtotal |  | Subtotal |  | ||
Your risk of developing Type II diabetes within 5 years *: | Total Risk Score | Â | ||||
6 - 11: Increased risk | Increased risk of developing type 2 diabetes | |||||
12 or more: High risk | May have undiagnosised type 2 diabetes or be at high risk of developing type 2 diabetes |