59 In recent years, metabolomic studies of large numbers of metabolites in blood and/or urine have identified novel predictors of DM risk, e.g. circulating levels of aromatic and

branch-chained amino acids, which are independent predictors of insulin resistance60 and DM risk. Metabolomic studies have identified novel pathophysiological mediators of metabolic syndrome, such as nicotinuric acid.61 Using a targeted metabolomic approach and measuring over 160 serum metabolites with flow #lifescience keyword# injection analysis tandem mass spectrometry in prospectively collected samples from large population-based studies, Floegel et al. identified a number of changes in sugar metabolites, amino acids, and choline-containing phospholipids that modestly improve prediction of DM risk.62 Identifying such metabolomic markers may prove to be useful in directing studies of Inhibitors,research,lifescience,medical the associated genes in at-risk populations.63 PREDICTING TYPE 1 DM RISK Autoimmune-mediated destruction of the insulin producing β-cells of the pancreatic islets results in type 1 DM. Increased risk for developing type 1 DM may be recognized by a family Inhibitors,research,lifescience,medical history of type 1 DM or other autoimmune

diseases, by the presence in the blood of a range of antibodies to insulin and islet-related antigens (e.g. islet-cell antibodies, Inhibitors,research,lifescience,medical insulin autoantibodies, antibodies to glutamic acid decarboxylase), or by the identification of a “high-risk” HLA type.64 Recently genomic studies combined with bioinformatics techniques have been able to identify a small number of SNPs that can rapidly and inexpensively predict the presence of the high-risk HLA-DR/DQ types,64 which may facilitate identification of those individuals who are candidates for studies of interventions to prevent complete β-cell loss and thereby prevent or ameliorate the type 1 DM.65 PERSONALIZED MEDICINE AND CHRONIC Inhibitors,research,lifescience,medical MICROVASCULAR COMPLICATIONS OF DM As a function of time and extent of hyperglycemic burden, individuals with DM are prone to develop renal,

retinal, or neurological damage that can result in renal Bumetanide failure, blindness, disabling pain, or lower-extremity amputations. However, not all patients with DM develop these complications, regardless of duration or degree of hyperglycemic control. Fifteen to twenty years after diagnosis of DM, 50%–80% have evidence for retinopathy,66 only a minority of which is vision-threatening, up to 30% have increased levels of albumin in the urine (an early stage in the development of nephropathy),67 and about 50% have symptoms of peripheral neuropathy.68 Randomized controlled trials, including DCCT,69 UPKDS,70 Kumamoto,71 ACCORD,72 and ADVANCE,73 demonstrate the potential to reduce or delay some or all of these risks by controlling hyperglycemia.