Energy balance

Intensive lifestyle intervention does not significantly improve objective physical examination measures of diabetic peripheral neuropathy (such as vibration sense or monofilament light touch) compared to control, except for a slight preservation of light touch sensation when both feet are considered together.

While lifestyle changes improve how patients *feel* (less pain, numbness), they may not always reverse objective nerve damage detectable by standard physical exams like monofilament testing. This highlights the importance of symptom management and prevention of progression, even if structural reversal is not achieved.