The management of metabolic diseases relies more on patients’ active and sustained engagement—once burnout leads to decreased motivation for self-management (e.g., reduced adherence to blood glucose monitoring), metabolic disorders will further worsen sleep, and insufficient sleep will in turn exacerbate insulin resistance through hypothalamic–pituitary–adrenal (HPA) axis dysfunction, eventually forming a metabolism-specific closed loop of “management slackness → metabolic abnormalities → sleep disorders” (31, 32). Here, INS is linked to sleep disorder.