Consent

Diabetes Database Informed Consent - Please read carefully

You are being asked if you would like to include your name and other information in the Diabetes Database. The purpose of the Database is to have available to investigators names of people who are interested in learning about and/or participating in diabetes research studies at Penn State. You must be 18 years of age or older to enroll yourself. If you are under the age of 18, your parent or guardian must enroll you.

Your name, contact information and other information, such as date of birth, whether or not you have diabetes, date of diagnosis, insulin use, and where you heard about the database will be collected. This information will be entered into a database on a computer and will remain in the database indefinitely. This means that unless you ask for the information to be deleted/removed, it will stay in the database.

Investigators (researchers) at Penn State who are interested in recruiting for diabetes-related studies will be able to request a list of names and information from the database. Your information will be made available to these investigators and/or their research study team members. They will contact you directly to find out if you are interested in learning more about their particular research studies which may have direct or indirect benefits to you, such as giving you the opportunity to learn more about diabetes. You are not obligated to participate in any research studies just because you are part of the database. You are only agreeing to be contacted about them.

For Parents of Minors (under age 18): You may add your child's name to the database, but your child may not add it on his/her own.

Your participation in this database is voluntary. You can change your mind at any time and ask for your information to be removed from the database by emailing luk10@psu.edu. You are not required to participate in any research study that you might be contacted about.

If you have questions about your rights as a research participant, you may contact the Office for Research Protections at 814-865-1775. You may also contact Kathryn Peters, who maintains the database, if you have questions. She can be contacted at 814-865-1392 or 1-800-393-0782. Her email address is luk10@psu.edu.  Her campus address is Penn State Institute for Diabetes and Obesity Recruitment, 206 Noll, Penn State, University Park, PA 16802.

Given this information, are you still interested in allowing your information to be added to the Diabetes Database?

This informed consent was reviewed and approved by the Biomedical Institutional Review Board at The Pennsylvania State University on 03/24/05 MBB. It will expire on 03/22/06 MBB.