EXTOD Exercise for Type 1 Diabetes

Research Research

The EXTOD Education study

The EXTOD Education study

The aim of the EXTOD Education study is to develop and pilot an education programme for people with type 1 diabetes (with accompanying training for health care professionals to deliver this programme) to guide insulin and carbohydrate adjustment for safe exercise. This work was undertaken with the help of colleagues from Leicester, Bedfordshire and Pinderfields.

This study is divided into two stages. The first stage develops an education programme aimed to support people with type 1 diabetes to exercise using the Medical Research Council (MRC) framework.

The second stage is a pilot randomised controlled trial that aims to collect the key variables to design a definitive trial to test the efficacy and cost effectiveness of the education package. A total of 96 patients came into this study, half of which received the education package that was developed in phase 1, the other half of which received usual care. Participants were followed up for six months.

The table below shows what measures were done at baseline and at 6 months

Clinical examination
  • Cardiovascular/respiratory/gastrointestinal/nervous system/feet
  • Blood pressure and heart rate
  • Height, weight, waist circumference
  • Body-fat content (bio-impedance)
Non fasting blood
  • HbA1c
  • FBC
  • Liver/renal function
  • GAD, IA-2 and zinc transporter autoantibodies (6 month assessment only)
  • C-peptide (baseline only)
  • Clarke's Hypoglycaemia Awareness Questionnaire
  • The Hypoglycaemia Fear Survey
  • Gold score, Edinburgh hypo survey, and hypoawareness score
  • Problem Areas in Diabetes Scale (PAID)
  • Diabetes Distress Scale for Adults with Type 1 Diabetes (T1-DDS)
  • Barriers to Physical Activity in Type 1 Diabetes (BAPAD-1) scale
  • EQ-5D
  • Blood glucose monitoring diary
  • Insulin monitoring diary
  • Activity diary
  • Small electronic device worn on wrist for seven days (GENEActiv actigraphy.


  • 4 week download of blood glucose monitor.
  • Wearing a monitor on stomach that continuously records glucose every 5 minutes for 7 days (optional) - Dexcom 5.
  • Postcard given at last visit for participant to provide anonymous feedback on the study.

The study completed in August 2019 and we hope to publish the final results in early 2020.

The results of this work informs the education material on this website.

Publications from this study

  1. Narendran P, Greenfield S, Troughton J, Doherty Y, Quann N, Thompson C, Litchfield I, Andrews RC; EXTOD Education Programme Development Team paper (Development of a group structured education programme to support safe exercise in people with Type 1 diabetes: the EXTOD education programme).
  2. Litchfield I, Andrews RC, Narendran P, Greenfield S paper (Patient and Healthcare Professionals Perspectives on the Delivery of Exercise Education for Patients With Type 1 Diabetes).