Environmental determinants of type 1 diabetes: from association to proving causality

Lauren M Quinn, F Susan Wong, Parth Narendran

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The rising incidence of type 1 diabetes (T1D) cannot be ascribed to genetics alone, and causative environmental triggers and drivers must also be contributing. The prospective TEDDY study has provided the greatest contributions in modern time, by addressing misconceptions and refining the search strategy for the future. This review outlines the evidence to date to support the pathways from association to causality, across all stages of T1D (seroconversion to beta cell failure). We focus on infections and vaccinations; infant growth and childhood obesity; the gut microbiome and the lifestyle factors which cultivate it. Of these, the environmental determinants which have the most supporting evidence are enterovirus infection, rapid weight gain in early life, and the microbiome. We provide an infographic illustrating the key environmental determinants in T1D and their likelihood of effect. The next steps are to investigate these environmental triggers, ideally though gold-standard randomised controlled trials and further prospective studies, to help explore public health prevention strategies.

Original languageEnglish
Article number737964
Number of pages15
JournalFrontiers in immunology
Publication statusPublished - 1 Oct 2021

Bibliographical note

Copyright © 2021 Quinn, Wong and Narendran.


  • type 1 diabetes (T1D)
  • seroconversion
  • auto-antibodies
  • autoimmunity
  • environmental factors
  • gut micro biome
  • obesity
  • infection - immunology


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