Exenatide Pregnancy Registry

Pregnancy Registry, Diabetes, BYETTA, byetta, Type 2 Diabetes

Data Forms for Exenatide Pregnancy Registry - Type 2 Diabetes in Pregnancy
If you are a pregnant woman with Type 2 diabetes:
You may begin your participation by calling the Exenatide Pregnancy Registry - Type 2 Diabetes in Pregnancy at 1-800-633-9081 and an associate will complete the enrollment forms via phone.

A Registry Associate will contact you or the appropriate healthcare provider (HCP) at different pregnancy milestones and postpartum follow-up to obtain additional information.
If you are a HCP initiating enrollment for your patient:
  • You may call the Exenatide Pregnancy Registry - Type 2 Diabetes in Pregnancy at 1-800-633-9081 and an associate will assist you with the enrollment process. If your patient is available to provide consent over the phone, an associate will complete the enrollment via phone.
  • Or you may download and print data collection forms directly from this website. Each form is accompanied by completion instructions. Follow the enrollment process described below:
  • Print the documents in the Registration Packet
  • Review Participant Information Sheet with patient. Sign and date the Registry Associate line to indicate you have conducted the consent process with your patient (strike through 'Registry Associate' and replace with 'HCP')
  • Complete the two Alternate Contact releases, along with the OB, Diabetes HCP, and Pediatrician Medical Release Forms
  • Complete the Registration and Obstetric History Forms
  • Provide copies of all forms completed to the participant AND to the Registry (fax forms to Registry at 1-866-764-8964)
  • Or you may ask your patient to call the Exenatide Pregnancy Registry - Type 2 Diabetes in Pregnancy directly at 1-800-633-9081 and an associate will complete the enrollment via phone.
Please click on the links below to print data collection forms:
Please call 1-800-633-9081 for assistance with completing the data collection forms.
Thank you for your interest in the Exenatide Pregnancy Registry - Type 2 Diabetes in Pregnancy.