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Conflict of interest: ZW, BSL, and SLH are named as co-inventors on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics, and have the right to receive royalty payment for inventions or discoveries related to cardiovascular diagnostics or therapeutics from Cleveland HeartLab, Quest Diagnostics, and Procter & Gamble

Impaired catabolism of branched-chain amino acidsmodulated by pathogenic variants in BCKDHA and loss-of-function alleles in PPM1Kcompromises tissue-selective disposal of these metabolites, thereby fostering insulin resistance and accelerating the progression of type 2 diabetes mellitus (30)

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