Clinical Research Directory

Inclusion Criteria: 1. T2D defined by ADA criteria. 2. Peripheral neuropathy based on the Toronto Diabetic Neuropathy Expert Group consensus criteria for "Confirmed diabetic sensorimotor peripheral neuropathy". 3. Moderate DPN severity with a UENS of 2-18. 4. Age between 30 and 75. 5. Under the care of an identified Primary Care Physician (PCP). Exclusion Criteria: 1. Any alternative cause for peripheral neuropathy. The following tests must have been found normal within the last 12 months or will be performed pre-randomization: vitamin B12, serum protein electrophoresis and immunofixation. ANA and TSH may be obtained if clinically indicated and not available from clinical records. 2. Family history of a non-diabetic neuropathy in a first-degree relative. 3. Severe or longstanding neuropathy: UENS \> 18 or history of foot ulceration or amputation. 4. Participants taking Coumadin or oral factor X or thrombin inhibitor therapy will be considered on an individual basis by the site investigator. 5. Severe edema, dermatologic or lower extremity condition that would increase risk of skin biopsy. 6. A serious medical condition that might shorten life span or prevent exercise. 7. Subjects with obesity or hypertension considered in a dangerous range (BMI\> 45, systolic BP \>170, or diastolic BP \>110) and those who fail a medically supervised graded maximal stress test will be excluded from the study for safety reasons. 8. An inability to understand or cooperate with the procedures of the study 9. Females who are pregnant at screening or actively plan to become pregnant during the study period, because of the marked changes in metabolism anticipated during pregnancy. 10. If ,in the investigators assessment, that participation in the study would be limited by a person's weight, size, or other physical condition.