***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Obesity and type 2 diabetes ( T2D ) are associated with abnormal cardiovascular autonomic function and increased risk for cardiac complications , especially after exercise . Since improvements at rest are not always observed after training , we investigated changes in resting and post-exercise autonomic function in obese women with and without T2D after16-week of walking training .  Heart rate ( HR ) variability ( HRV ) and baroreflex sensitivity ( BRS ) were measured at rest and 20 min after a 20 min bout of treadmill exercise at 65 % VO2 peak in obese women with ( n = 8) and without T2D ( n = 12 ) before and after training . HRV was analyzed by frequency-domain [ high- ( HF ) power and low-frequency ( LF ) ] and BRS by the sequence method . Exercise training induced similar significant changes in VO2 peak , resting systolic blood pressure ( SBP ) and post-exercise autonomic function in both groups . Training increased VO2 peak ( 6 % ; P < 0.01 ) and decreased resting SBP ( 8 % ; P < 0.001 ) . Increased post-exercise HR recovery ( 5 % ; P < 0.001 ) , HF power ( 14 % ; P < 0.05 ) , LF power ( 14 % ; P < 0.05 ) and BRS ( 86 % ; P < 0.001 ) were also observed . Resting autonomic function and post-exercise SBP were not altered after training . In conclusion , endurance training reduced blood pressure without changes in HRV and BRS at rest , but training increased HRV and BRS during the recovery of acute endurance exercise indicating an improved post-exercise autonomic modulation of HR , which was similar in obese women with and without T2D Objective To evaluate the effect of 8-week moderate intensity aerobic ( heart-rate reserve 40–60 % ) exercise on neuropathy quality of life in type 2 diabetes . Methods A single blind , parallel-group , r and omized controlled trial was carried out in a tertiary setting . People with type 2 diabetes were eligible for the study if they had clinical neuropathy which was defined by a minimum score of seven on the Michigan diabetic neuropathy score . Following which , the patients were r and omly assigned to an 8-week program by a computer-generated r and om number tables to intervention or control group . Repeated measure analysis of variance was used for data analysis ( p < 0.05 was considered significant ) . Results There were 47 participants in the control group and 40 participants in the study group after r and omization but 37 from the control group and 29 from the intervention group completed the final analysis . The two groups had a significant difference , pre – post intervention in scores of pain ( F = 7 , p = 0.01 ) , sensory symptoms ( F = 4.60 , p = 0.04 ) , restricted activities of daily living ( F = 4.97 , p = 0.03 ) , disruptions in social relationships ( F = 5.43 , p = 0.02 ) , specific impact on quality of life ( F = 9.28 , p < 0.001 ) overall quality of life ( F = 28.72 , p < 0.001 ) , and total score ( F = 31.10 , p < 0.001 ) . Degrees of freedom for all the components were 1 , 62 . Conclusion Moderate intensity aerobic exercise is cornerstone in improving the quality of life of individuals with peripheral neuropathy in type 2 diabetes Background — The Epidemiology of Diabetes Interventions and Complications ( EDIC ) study , a prospect i ve observational follow-up of the Diabetes Control and Complications Trial ( DCCT ) cohort , reported persistent benefit of prior intensive therapy on retinopathy and nephropathy in type 1 diabetes mellitus . We evaluated the effects of prior intensive insulin therapy on the prevalence and incidence of cardiac autonomic neuropathy ( CAN ) in  former DCCT intensive and conventional therapy subjects 13 to 14 years after DCCT closeout . Methods and Results — DCCT autonomic measures ( R-R variation with paced breathing , Valsalva ratio , postural blood pressure changes , and autonomic symptoms ) were repeated in 1226 EDIC subjects in EDIC year 13/14 . Logistic regression models were used to calculate the odds of incident CAN by DCCT treatment group after adjustment for DCCT baseline covariates , duration in the DCCT , and quantitative autonomic measures at DCCT closeout . In EDIC year 13/14 , the prevalence of CAN using the DCCT composite definition was significantly lower in the former intensive group versus the former conventional group ( 28.9 % versus 35.2 % ; P=0.018 ) . Adjusted R-R variation was significantly greater in the former DCCT intensive versus the former conventional group ( 29.9 versus 25.9 ; P<0.001 ) . Prior DCCT intensive therapy reduced the risks of incident CAN by 31 % ( odds ratio , 0.69 ; 95 % confidence interval , 0.51 to 0.93 ) and of incident abnormal R-R variation by 30 % ( odds ratio , 0.70 ; 95 % confidence interval , 0.51 to 0.96 ) in EDIC year 13/14 . Conclusions — Although CAN prevalence increased in both groups , the incidence was significantly lower in the former intensive group compared with the former conventional group . The benefits of former intensive therapy extend to measures of CAN up to 14 years after DCCT closeout BACKGROUND Post-trial monitoring of patients in the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) examined whether risk reductions for microvascular and macrovascular disease , achieved with the use of improved blood-pressure control during the trial , would be sustained . METHODS Among 5102 UKPDS patients with newly diagnosed type 2 diabetes mellitus , we r and omly assigned , over a 4-year period beginning in 1987 , 1148 patients with hypertension to  tight or less-tight blood-pressure control regimens .  The 884 patients who underwent post-trial monitoring  were asked to attend annual UKPDS clinics for the first 5 years , but no attempt was made to maintain their previously assigned therapies . Annual question naires completed by patients and general practitioners were used to follow patients who were unable to attend the clinic in years 1 through 5 , and question naires were used for all patients in years 6 to 10 . Seven prespecified aggregate clinical end points were examined on an intention-to-treat basis , according to the previous r and omization categories . RESULTS Differences in blood pressure between the two groups during the trial disappeared within 2 years after termination of the trial . Significant relative risk reductions found during the trial for any diabetes-related end point , diabetes-related death , microvascular disease , and stroke in the group receiving tight , as compared with less tight , blood-pressure control were not sustained during the post-trial follow-up . No risk reductions were seen during or after the trial for myocardial infa rct ion or death from any cause , but a risk reduction for peripheral vascular disease associated with tight blood-pressure control became significant ( P=0.02 ) . CONCLUSIONS The benefits of previously improved blood-pressure control were not sustained when between-group differences in blood pressure were lost . Early improvement in blood-pressure control in patients with both type 2 diabetes and hypertension was associated with a reduced risk of complications , but it appears that good blood-pressure control must be continued if the benefits are to be maintained . ( UKPDS 81 ; Current Controlled Trials number , IS RCT N75451837 . Objective : To test the hypothesis that 12 months of seal oil omega-3 polyunsaturated fatty acids ( ω-3 PUFA ) supplementation will stop the known progression of diabetic sensorimotor polyneuropathy ( DSP ) in type 1 diabetes mellitus ( T1DM ) . Methods : Individuals with T1DM and evidence of DSP as determined by a Toronto Clinical Neuropathy Score ≥1 were recruited to participate in a single-arm , open-label trial of seal oil ω-3 PUFA supplementation ( 10 mL·d−1 ; 750 mg eicosapentaenoic acid , 560 mg docosapentaenoic acid , and 1,020 mg docosahexaenoic acid ) for 1 year . The primary outcome was the 1-year change in corneal nerve fiber length ( CNFL ) measured by in vivo corneal confocal microscopy , with sensory and nerve conduction measures as secondary outcomes . Results : Forty participants ( 53 % female ) , aged 48 ± 14 years , body mass index 28.1 ± 5.8 with diabetes duration of 27 ± 18 years , were enrolled . At baseline , 23 participants had clinical DSP and 17 did not . Baseline CNFL was 8.3 ± 2.9 mm/mm2 and increased 29 % to 10.1 ± 3.7 mm/mm2 ( p = 0.002 ) after 12 months of supplementation . There was no change in nerve conduction or sensory function . Conclusions : Twelve months of ω-3 supplementation was associated with increase in CNFL in T1DM . Clinical Trials.govidentifier : NCT02034266 . Classification of evidence : This study provides Class IV evidence that for patients with T1DM and evidence of DSP , 12 months of seal oil omega-3 supplementation  increases CNFL BACKGROUND Diabetes is the most important cause of peripheral neuropathy ( DPN ) . No definitive treatment for DPN has been established , and very few data on the role of exercise training on DPN have been reported . AIM OF THE STUDY We sought to examine the effects of long-term exercise training on the development of DPN in both Types 1 and 2 diabetic patients . PARTICIPANTS AND METHODS Seventy-eight diabetic patients without signs and symptoms of peripheral DPN were enrolled , r and omized , and subdivided in two groups : 31 diabetic participants [ 15 f , 16 m ; 49+/-15.5 years old ; body mass index ( BMI ) = 27.9+/-4.7 ] , who performed a prescribed and supervised 4 h/week brisk walking on a treadmill at 50 % to 85 % of the heart rate reserve ( exercise group : EXE ) , and a  control group of 47 diabetic participants ( CON ; 24 f , 23 m ; 52.9+/-13.4 years old ; BMI = 30.9+/-8.4 ) .  Vibration perception threshold ( VPT ) , nerve distal latency ( DL ) , nerve conduction velocity ( NCV ) , and nerve action potential amplitude ( NAPA ) in the lower limbs were measured . RESULTS We found significant differences on Delta ( delta ) in NCV for both peroneal and sural motor nerve between the EXE and CON groups during the study period ( P<.001 , for both ) . The percentage of diabetic patients that developed motor neuropathy and sensory neuropathy during the 4 years of the study was significantly higher in the CON than the EXE group ( 17 % vs. 0.0 % , P<.05 , and 29.8 % vs. 6.45 % , P<.05 , respectively ) . In addition , the percentage of diabetic patients who developed increased VPT ( 25 V ) during the study was significantly higher in the CON than the EXE group ( 21.3 % vs. 12.9 % , P<.05 ) . Change on Hallux VPT from baseline to the end of the study was significantly different between the EXE and CON groups ( P<.05 ) ; no significant change in Malleolus VPT between the two groups occurred . CONCLUSIONS This study suggests , for the first time , that long-term aerobic exercise training can prevent the onset or modify the natural history of DPN OBJECTIVE To evaluate the efficacy and safety of α-lipoic acid ( ALA ) over 4 years in mild-to-moderate diabetic distal symmetric sensorimotor polyneuropathy ( DSPN ) . RESEARCH DESIGN AND METHODS In a multicenter r and omized double-blind parallel-group trial , 460 diabetic patients with mild-to-moderate DSPN were r and omly assigned to oral treatment with 600 mg ALA once daily ( n = 233 ) or placebo ( n = 227 ) for 4 years . Primary end point was a composite score ( Neuropathy Impairment Score [NIS]–Lower Limbs [ NIS-LL ] and seven neurophysiologic tests ) . Secondary outcome measures included NIS , NIS-LL , nerve conduction , and quantitative sensory tests ( QSTs ) . RESULTS Change in primary end point from baseline to 4 years showed no significant difference between treatment groups ( P = 0.105 ) . Change from baseline was significantly better with ALA than placebo for NIS ( P = 0.028 ) , NIS-LL ( P = 0.05 ) , and NIS-LL muscular weakness subscore ( P = 0.045 ) . More patients showed a clinical ly meaningful improvement and fewer showed progression of NIS ( P = 0.013 ) and NIS-LL ( P = 0.025 ) with ALA than with  placebo . Nerve conduction and QST results did not significantly worsen with placebo . Global assessment of treatment tolerability and discontinuations due to lack of tolerability did not 
    Output:
    
Conclusions Recent research indicates that dietary interventions are effective in modifying diabetic neuropathy in animal models , and there are promising data that they may also ameliorate diabetic neuropathy in humans .
However , there is emerging evidence that lifestyle interventions are effective in individuals with established diabetic neuropathy .
In addition to the observed clinical value of lifestyle interventions , there is emerging evidence of effects on biochemical pathways that improve muscle function and affect other organ systems , including the peripheral nerve .