Understanding The Exposome In Type 2 Diabetes: Integrating Lifestyle Behaviors And Environmental Pollutants In Disease Risk And Prevention

The exposome, encompassing the totality of environmental, lifestyle, and biological exposures across the life course, offers a comprehensive framework for understanding the multifactorial etiology of type 2 diabetes (T2D). This review synthesizes evidence on the interplay between external exposures (e.g., pollutants, diet, socioeconomic status), internal domains (e.g., microbiome, metabolic alterations), and biological mechanisms (e.g., oxidative stress, hormonal disruption, epigenetic regulation) that collectively influence T2D risk. Technological advances, including geospatial tools, wearable devices, and multi-omics integration, are reshaping exposome research, enabling precise exposure assessment and mechanistic insight. Moreover, we highlight the modifying roles of socioeconomic status and education, the gut microbiome, and transgenerational influences in shaping T2D susceptibility. Public health strategies emphasizing lifestyle modification, environmental risk reduction, and equity-focused interventions remain central to prevention, while translation of exposome insights into policy and precision public health offers new opportunities. Finally, we outline future research directions, emphasizing artificial intelligence–driven analytics, longitudinal and multi-generational studies, and methodological innovations to bridge existing gaps. Collectively, this review underscores the importance of a systems-level, exposome-informed approach to mitigate the growing burden of T2D globally.