As the diabetic phenotype in this study was not advanced or severe (we excluded subjects requiring exogenous insulin; average glycated hemoglobin was 6.9%), this highlights the metabolic inflexibility of the cardiomyocyte in the setting of lower grades of insulin resistance, and also the ability of hyperpolarized MR to detect early changes in myocardial metabolism in diabetes mellitus. This evidence concerns the gene INS and diabetes mellitus.