A landscape analysis of perinatal mental health delivery among stakeholders in Ecuador and Peru.

Diabetes mellitus is a disorder of carbohydrate, fat, and protein metabolism and is characterized by persistent hyperglycemia. It is broadly classified into type 1 diabetes, type 2 diabetes, gestational diabetes, and other specific forms such as monogenic and secondary diabetes. Type 1 diabetes results from autoimmune destruction of pancreatic β-cells, leading to absolute insulin deficiency, whereas type 2 diabetes is characterized by insulin resistance combined with progressive β-cell dysfunction. Gestational diabetes occurs during pregnancy and is associated with both short- and long-term metabolic consequences for the mother and offspring. Clinically, patients are diagnosed with diabetes mellitus by fasting blood glucose (FBG) of ≥7.0 mmol/L (126 mg/dL); random blood glucose (RBG) ≥ 11.1 mmol/L (200 mg/dL) or blood glucose ≥ 11.1 mmol/L (200 mg/dL) 2 h after oral glucose tolerance test (OGTT) []. The increasing prevalence of diabetes mellitus is becoming a worldwide health problem. In 2017, it was reported that about 451 million people across the world had diabetes, with a projected increase to 693 million by 2045 []. As of 2021, the worldwide prevalence had increased to approximately 537 million worldwide, with projections of over 800 million cases by 2045. In the U.S., 1.2 million people are diagnosed with diabetes each year, and 40.1 million people are currently reported to be living with diabetes []. Several risk factors have been attributed to the increasing prevalence of diabetes, which include excessive smoking, poor nutrition, sedentary lifestyle, and circadian disruption. Maintenance of normal circadian rhythms is crucial for sustaining a healthy life. Hence, aberrant light exposure, such as light at night, irregular work schedules, or frequent travel across time zones, may disrupt the circadian system, leading to desynchronization of circadian rhythm and increasing the risk for type 2 diabetes mellitus. In recent years, studies have revealed disruption of the circadian system as a predominant risk factor in the modern world. For instance, approximately 20% of the workforce is involved in shift work, while 33% of individuals report achieving less than 6 h of sleep [], and up to 69% of people suffer jetlag []. Shift workers are at a greater risk of developing type 2 diabetes than day workers, with the highest risk reported among individuals working irregular rotating shifts that involve night shifts []. Notably, shiftwork alone was reported to increase the susceptibility of developing type 2 diabetes mellitus by 30% []. This review focuses on type 2 diabetes, which accounts for over 90% of diabetes cases worldwide and is closely linked to modifiable factors such as obesity, lifestyle, and circadian disruption, making it a critical target for mechanistic investigation and therapeutic intervention. We discuss recent advances in the circadian regulation of glucose metabolism and their implications for understanding the pathogenesis and treatment of type 2 diabetes; accordingly, the term “diabetes” in this review refers specifically to type 2 diabetes mellitus.