Finally, four studies included in the T1DM meta-analysis (Singh et al, Leiva-Gea et al, Elsherbiny et al, and Mokhtari et al) included subjects who were started on insulin therapy prior to measurement of microbiome which does not represent the ideal study design as insulin therapy and appropriate glycemic control could have an effect on the gut microbial composition. The gene discussed is INS; the disease is type 1 diabetes mellitus.