Rider et al. successfully utilised hyperpolarized [1-13C] pyruvate MRS to assess downstream metabolism of [1-13C] pyruvate via PDH (pyruvate dehydrogenase, [13C] bicarbonate), lactate dehydrogenase ([1-13C] lactate), and alanine transaminase ([1-13C] alanine), in 5 patients with T2D and 5 controls at baseline, and repeated these measurements in 5 of these participants (3 T2D, 2 controls) 45 min after a 75 g oral glucose challenge [54]. Here, PDP1 is linked to type 2 diabetes mellitus.