# Recent Advances of Integrative Bio-Omics Technologies to Improve Type 1 Diabetes (T1D) Care
###### Abstract  
Type 1 diabetes (T1D) is a complex autoimmune disease that currently cannot be cured, only managed. Optimal treatment the of T1D symptoms, requires a multidisciplinary care team, including endocrinologists, educators, primary care providers, health care specialists, genetic counselors, and data scientists. This review summarizes how an integrative approach to T1D drives innovation and quality improvements in health care. Specifically, we highlight how \"omics\" technologies facilitate the understanding of different aspects of the disease, including prevention, pathogenesis, diagnostics, and treatment. Furthermore, we explore how biological data can be combined with personal and electronic health records to tailor medical interventions to the individual's biology and lifestyle. We conclude that truly personalized medicine will not be limited to one data source but will emerge from the integration of multiple sources and disciplines that together will support individuals with T1D in their everyday life. genomics; diabetes; big data; T1D +
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on associations among different disease states is currently limited. By using aggregated \"-omics\" data, relationships between different genetic predispositions and environmental influences on T1D can not only be explored but may help to identify at-risk individuals requiring early intervention. An example of a successful approach, that uncovered the interplay between individual genetic and environment, is The Environmental Determinants of Diabetes in the Young (TEDDY) study, for which researchers measured a wide variety of environmental triggers in children who were at high genetic risk for T1D [8]. There is an ongoing opportunity to explore connections between seemingly disconnected environmental variables, by using the resulting database of exposures and metabolic profiles. Investigators linked a metabolic signature and subsequent alteration in specific physiologic processes (i.e., upregulation of energy-producing pathways, downregulation of lipogenic processes) that preceded [8; 9]. In the TEDDY study, researchers were able to establish a timeline from when these physiological processes occur to complete disease onset, preceding the development of T1D-related autoimmunity by up to 12 months [9]. Further commonalities can be found in the pathogenesis of T1D between different disease states. For example, investigators identified that the pentose phosphate pathway and pyrimidine metabolism were altered in children with islet autoimmunity born by Cesarean section [10]. The profile of these transcriptomic differences showed similarities with gene expression alterations during the activation of CD4+ T lymphocytes and other immune system factors like those found in islet autoimmunity in individuals with T1D [11]. The investigators concluded that the transcriptomic differences found within an individual delivered by Cesarean section may lead to the potential development of islet autoimmunity and T1D [10]. Aggregation of available \"-omics\" data and investigation of possible associations may allow profiles of at-risk individuals to be constructed [12]. The inclusion of other environmental factors and disease processes can create a more comprehensive assessment of T1D pathogenesis [13]. Recent studies uncovered correlations between immune insults, such as virus infection (i.e., enterovirus), with the onset of immune mechanisms imitating beta-cell antigens, and therefore, demonstrated a molecular mechanism underpinning the development of T1D as a consequence of exogenous exposure [14]. Psychological factors, such as physiological responses to generalized stress, are known to affect T1D disease onset and management [15; 16; 17]. It has been demonstrated that negative influences in the individual's environment, such as the presence of family conflict, compromise metabolic control, and therefore increase the risk for T1D-related complications [18].