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Doctor and Patient

Patient Interest Form

Are you an adult with type 1 diabetes interested in receiving Lantidra? Please complete the Patient Interest Form below.


If you qualify for treatment, a patient screening process will need to be completed. Your medical information will be reviewed by the clinical team at University of Illinois-Health (UIH).

Have you always required insulin since your diagnosis?
Do you currently use an insulin pump?
Do you currently use a continuous glucose monitor?
Do you currently see an endocrinologist or diabetes specialist?
Have you ever tested positive for diabetes antibodies?
Are you on any anti-diabetes medications besides insulin?
Do you currently smoke cigarettes?

Thanks for submitting!

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