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Recent literature has linked several facets of gut health with the onset of T1D in humans and rodent models 4, 6, 10. Altered intestinal microbiota in connection to T1D has been reported in Finnish 7, 8, 11, 12, German 13, Italian 14, Mexican 15, American (Colorado) 16 and Turkish 17 children. Common findings include increased numbers of Bacteroides species, and deficiency of bacteria that produce short-chain fatty acids (SCFAs) 7, 8 in cases of T1D or islet autoimmunity (IA) 8, 11, 15, 18. Corroborating these findings, decreased levels of SCFA-producing bacteria were found in adults with type 2 diabetes (T2D) 19. In addition, increased intestinal permeability 14 and decreased microbial diversity 12 after IA but before T1D diagnosis have been reported. Studies using the nonobese diabetic (NOD) mouse model have determined immune mechanisms that mediate the protective effects of SCFAs 9 and the microbiome-linked sex bias in autoimmunity 20. NOD mice fed specialized diets resulting in high bacterial release of the SCFAs acetate and butyrate were almost completely protected from T1D 9. A study in a streptozotocin-induced T1D mouse model demonstrated that bacterial products recognized in pancreatic lymph nodes contribute to pathogenesis 21. FAST Turnaround, 15" Memory Bear, Custom Teddy Bear from Loved Ones Clothes, Memorial Bear, Keepsake Stuffed Bear, Personalized Remembrance Bonifacio, E. et al. Harmonization of glutamic acid decarboxylase and islet antigen-2 autoantibody assays for National Institute of Diabetes and Digestive and Kidney Diseases consortia. J. Clin. Endocrinol. Metab. 95, 3360–3367 (2010). If my mouth doesn't say it my face definitely will | coffee mug made for a farm cow loving sarcastic person de Goffau, M. C. et al. Fecal microbiota composition differs between children with β-cell autoimmunity and those without. Diabetes 62, 1238–1244 (2013).

Hagopian, W. A. et al. The Environmental Determinants of Diabetes in the Young (TEDDY): genetic criteria and international diabetes risk screening of 421 000 infants. Pediatr. Diabetes 12, 733–743 (2011). American Diabetes Association. 2. Classification and diagnosis of diabetes. Diabetes Care 38, S8–S16 (2015). Hober, D. & Sauter, P. Pathogenesis of type 1 diabetes mellitus: interplay between enterovirus and host. Nat. Rev. Endocrinol. 6, 279–289 (2010). Markle, J. G. et al. Sex differences in the gut microbiome drive hormone-dependent regulation of autoimmunity. Science 339, 1084–1088 (2013). Alkanani, A. K. et al. Alterations in intestinal microbiota correlate with susceptibility to type 1 diabetes. Diabetes 64, 3510–3520 (2015).Truong, D. T. et al. MetaPhlAn2 for enhanced metagenomic taxonomic profiling. Nat. Methods 12, 902–903 (2015). L.A.F., W.A.H., R.A.O., K.V. and S.A.S. designed the study, contributed to analysis and wrote the manuscript. Å.L., M.J.R., J.-X.S., A.-G.Z., J.T., B.A., J.P.K. and M.N.W. contributed to analysis and reviewed the manuscript. All authors contributed to discussions and editing of the manuscript. Corresponding author Hippisley-Cox, J., Coupland, C. & Brindle, P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. Br. Med. J. 357, j2099 (2017). Jin-Xiong She, Diane Hopkins, Leigh Steed, Jennifer Bryant, Katherine Silvis, Melissa Gardiner, Richard McIndoe, Ashok Sharma, Katherine Silvis, Diane Hopkins, Leigh Steed, Jennifer Bryant, Melissa Gardiner, Leigh Steed & Leigh Steed Suvi Ahonen, Mari Åkerlund, Heikki Hyöty, Sinikka Jäminki, Mikael Knip, Merja Koskinen, Mirva Koreasalo, Kalle Kurppa, Jarita Kytölä, Maria Lönnrot, Elina Mäntymäki, Tiina Niininen, Sari Niinistö, Mia Nyblom, Sami Oikarinen, Jenna Rautanen, Anne Riikonen, Miia Pekkola, Suvi M. Virtanen, Suvi M. Virtanen, Mirva Koreasalo, Sari Niinistö, Anne Riikonen, Mikael Knip, Heikki Hyöty, Maria Lönnrot, Tiina Niininen, Kalle Kurppa & Kalle Kurppa

Maffeis, C. et al. Association between intestinal permeability and faecal microbiota composition in Italian children with beta cell autoimmunity at risk for type 1 diabetes. Diabetes Metab. Res. Rev. 32, 700–709 (2016). Krischer, J. P. et al. Genetic and environmental interactions modify the risk of diabetes-related autoimmunity by 6 years of age: the TEDDY study. Diabetes Care 40, 1194–1202 (2017). Anne Hekkala, Henna Holappa, Anni Ikonen, Miia Kähönen, Minna-Liisa Koivikko, Tiina Latva-aho, Katja Multasuo, Teija Mykkänen, Paula Ollikainen, Sirpa Pohjola, Aino Stenius, Päivi Tossavainen, Riitta Veijola, Irene Viinikangas, Miia Kähönen, Aino Stenius, Miia Kähönen & Riitta Veijola Flower Girl Bears Personalised Teddy Bear Stuffed Animal Bear Custom Flower Girl Doll Name Teddy Bear Gift Idea Wedding Flower Girl Bears Noble, J. A. & Valdes, A. M. Genetics of the HLA region in the prediction of type 1 diabetes. Curr. Diabetes Rep. 11, 533–542 (2011).Soyucen, E. et al. Differences in the gut microbiota of healthy children and those with type 1 diabetes. Pediatr. Int. 56, 336–343 (2014).