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Front. Endocrinol. | doi: 10.3389/fendo.2019.00592

Environmental factors associated with type 1 diabetes

 Susanna Esposito1*, Giada Toni1, Giorgia Tascini1, Elisa Santi1, Maria Giulia Berioli1 and  Nicola Principi2
  • 1University of Perugia, Italy
  • 2University of Milan, Italy

Type 1 diabetes (T1D) is a chronic autoimmune disorder that leads to progressive pancreatic ß-cell destruction and culminates in absolute insulin deficiency and stable hyperglycaemia. It is very likely that environmental factors play a role in triggering islet autoimmunity. Knowing whether they have true relevance in favouring T1D development is essential for the effective prevention of the disease. Moreover, prevention could be obtained directly interfering with the development of autoimmunity through autoantigen-based immunotherapy. In this narrative review, the present possibilities for the prevention of T1D are discussed. Presently, interventions to prevent T1D are generally made in subjects in whom autoimmunity is already activated and autoantibodies against pancreatic cell components have been detected. Practically, the goal is to slow down the immune process by preserving the normal structure of the pancreatic islets for as long as possible Unfortunately, presently methods able to avoid the risk of autoimmune activation are not available. Elimination of environmental factors associated with T1D development, reverse of epigenetic modifications that favour initiation of autoimmunity in subjects exposed to environmental factors and use of autoantigen-based immunotherapy are possible approaches, although for all these measures definitive conclusions cannot be drawn. However, the road is traced and it is possible that in a not so distant future an effective prevention of the disease to all the subjects at risk can be offered.

Keywords: Diet, gut micribiota, Immunotherapy, Infections, Primary Prevention, type 1 diabetes

Received: 09 Apr 2019; Accepted: 12 Aug 2019.

Edited by:

Åke Sjöholm, Division of Endocrinology and Diabetology, Department of Internal Medicine, Gävle Hospital, Sweden

Reviewed by:

Jon D. Piganelli, University of Pittsburgh, United States
Åke Lernmark, Lund University, Sweden
Kimber Simmons, The Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, United States  

Copyright: © 2019 Esposito, Toni, Tascini, Santi, Berioli and Principi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Susanna Esposito, University of Perugia, Perugia, Italy,