UPMC MCADD Research Study Pre-Screener

Who are you completing this questionnaire for?

I am completing this for myself I am completing this for my child I am completing this for someone I care for

What is the age of the person who may participate?

Under 4 years old 4-11 years old 12-17 years old 18-29 years old 30-44 years old 45+ years old

Has the person been diagnosed with Medium-chain acyl-CoA dehydrogenase deficiency (MCAD deficiency or MCADD)?

Yes No I'm not sure

How was the diagnosis made?

Newborn screening Genetic testing Metabolic specialist diagnosis I'm not sure

Shown only when the person has already been diagnosed.

Growing up, did the person ever experience any of the following? Select all that apply.

Severe or repeated low blood sugar episodes Difficulty going long periods without food Hospital visits related to low blood sugar Told by a doctor to avoid fasting None of the above I'm not sure

Were you (or the person) ever told by a doctor that they may have a fatty acid oxidation disorder, such as MCAD deficiency?

Yes No I'm not sure

Participants in this study would need to travel to Pittsburgh, Pennsylvania for study visits. Travel and lodging reimbursement are provided. Would this be possible?

Yes Maybe / I would like more information No

The study includes 3 in-person visits over about 5 weeks, continuous glucose monitoring, and blood draws during visits. Would the participant likely be willing to complete these study activities?

Yes Maybe / need more information No

Has the person been diagnosed with type 1 or type 2 diabetes?

Yes No Not sure

Is the person currently pregnant, breastfeeding, or planning to become pregnant during the study period?

Yes No Not applicable

Full Name

Email Address

Phone Number

Date of Birth

Collected after qualification to support study follow-up and record completeness.

City and State

Are you happy for CliniContact to contact you about future research opportunities?

Yes No

What types of studies would you be interested in?