Decoding the exposome for type 1 diabetes prevention: A scoping review of environmental determinants

To synthesize existing evidence on environmental factors influencing T1D development and progression, describe methods for exposome assessment, and identify current research gaps.

This review follows the JBI methodology and PRISMA-ScR guidelines. A comprehensive literature search was performed in PubMed, Embase, CINAHL, Web of Science and Google Scholar in November 2024, with alerts screening up to August 2025. We systematically reviewed studies examining environmental exposures across the lifespan in relation to T1D incidence, outcomes, and complications.

Out of 982 records screened, 109 studies were included. Most studies focused on T1D development, while few addressed exposome determinants of disease progression. Eighteen exposure types were identified: 5 from the general external exposome (e.g., meteorological conditions, urban/rural environment, psychosocial factors); 12 from the specific external exposome (e.g., diet including breastfeeding and cow's milk, infectious agents primarily enteroviruses, atmospheric pollutants like NOx, O₃, SO₄, PM₁₀); and one from the internal exposome (e.g., gut microbiota dysbiosis, metabolic imbalance).

Infectious agents, air pollutants, and early-life diet are well studied and consistently associated with T1D onset. However, little is known about the role of cumulative and combined exposures, or the exposome's influence on disease progression and complications. Comprehensive research integrating exposome assessment across the life course is essential to improve T1D prevention and clinical management.