Respiratory infections and type 1 diabetes: Potential roles in pathogenesis

Abstract

Among the environmental factors associated with type 1 diabetes (T1D), viral infections of the gut and pancreas has been investigated most intensely, identifying enterovirus infections as the prime candidate trigger of islet autoimmunity (IA) and T1D development. However, the association between respiratory tract infections (RTI) and IA/T1D is comparatively less known. While there are significant amounts of epidemiological evidence supporting the role of respiratory infections in T1D, there remains a paucity of data characterising infectious agents at the molecular level. This gap in the literature precludes the identification of the specific infectious agents driving the association between RTI and T1D. Furthermore, the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on the development of IA/T1D remains undeciphered. Here, we provide a comprehensive overview of the evidence to date, implicating RTIs (viral and non-viral) as potential risk factors for IA/T1D.

Keywords: autoimmunity; respiratory infection; type 1 diabetes; virome; virus.

FIGURE 1

Graphic summary of studies reporting association between RTIs and islet autoimmunity (IA)/type 1 diabetes (T1D) grouped by participant age during period of infection., , , , , , , , , , , , , , , , , Measures of exposure are categorised by insurance/medical claims data, self‐reported data and molecular data. Each study is represented by the region(s) of the study setting, with the study group or first author in brackets. ABIS = All Babies in Southeast Sweden study; DIPP = Type 1 Diabetes Prediction and Prevention study; MIDIA = Norwegian Environmental Triggers of Type 1 Diabetes study; TEDDY = the Environmental Determinants of Diabetes in the Young study; TRIGR = Trial to Reduce Insulin‐Dependent Diabetes Mellitus.