Overview
Since 2000, diabetes (all types combined) has been the leading cause of death in women and the second in men in Mexico, which ranks second in Latin America and sixth in the world in terms of diabetes prevalence. While the 4th Article of the Mexican Constitution establishes that "everyone has the right to health protection,” the Mexican health system offers very different health benefits depending on the individual’s economic status (formal vs informal job), population sector and place of residence (urban vs rural, for example). The health system is divided into a public and a private sector.

The public sector includes social security institutions such as the Mexican Social Security (IMSS), Institute for State Workers' Safety and Social Services (ISSSTE), Mexican Petroleum Medical Services (PEMEX), National Defense Secretary (SEDENA), Health Service of the Secretariat of the Navy (SEMAR) and the Social Security Institute for the Mexican Armed Forces (ISSFAM). All of them provide social and health benefits to students, active or retired workers and their families in the clinics and medical hospitals that belong to those institutions. For the population without social security, there are some institutions and programs that provide health services, such as INSABI and SNDIF. There are two types of schemes: Compulsory (workers, members of production cooperatives, and students, and Voluntary (people without formal employment who have economic difficulties).

The private sector is made up of private clinics and hospitals, along with private insurance schemes. Persons with capacity to pay, approximately 17 percent of the population, cover a percentage or all of their expenses with out-of-pocket payments. The processes and programs of care for diabetes differ between the private and each of the public institutions within the Mexican Republic.

What happens if you need to see a doctor?
In the Public Sector, if you are a rights holder (someone protected by public insurance schemes) your first contact will be a general MD or a student supervised by a general MD who will prescribe or transfer you to a specialty MD when needed. In both cases, it will take time and lots of waiting.

In the Private Sector, general or specialty MDs are reachable within a shorter and more reasonable time-frame, but at a very high cost.

Who decides what doctors can prescribe?
The Federal Commission for Protection against Health Risks of the Mexican Government (COFEPRIS) analyses and approves new products, services and other items related to human consumption. COFEPRIS, together with the Health Ministry, decide and regulate all prescription pharmaceuticals.

Practically, what is it like to live with type 1 diabetes in Mexico?
Differences between diabetes types are mostly unknown to the public. In general, people with diabetes in Mexico are passively discriminated against and struggle for medical and non-medical care. This discrimination varies from restricting access to diabetes education, to increasing costs of insulin, blood sugar meters and other supplies. It can also result in inadequate attention from some health care professionals, usually by those from the public sector and who haven’t been properly actualized and/or trained in diabetes care and education. This treatment endangers people with diabetes and their family’s peace of mind. There are some diabetes education programs provided by public health institutes, however the vast majority are for type 2 diabetes and they are not always available. Therefore, many children, adolescents, and their parents and other adults living with diabetes seek education for themselves either through the internet, social networks or non-profit organizations such as the Mexican Associations which are located throughout the Mexican Republic and belong to the Mexican Diabetes Federation.

The public healthcare system provides, not always on a regular basis, some types of oral hypoglycemic agents, human insulin and insulin analogues. Medical care (mostly by general practitioners) and nutritional care are also provided, however, appointments can take a long time to be scheduled and up to several months to be provided. Currently, the healthcare system does not cover or support the acquisition of insulin pumps or continuous glucose monitoring devices. Some laboratory tests are covered by the healthcare system, however diabetic eye exams, oral health care, psychological care and consultations with physical activators often must be paid out-of-pocket by the patient.

People with diabetes must spend a large percentage of their income to cover most of the essential inputs for managing their diabetes. Among these inputs are: insulins (either because of shortages by the health system or because it only provides for human insulin), pen needles, syringes, glucometer, lancets, glucagon and ketone strips. Sometimes even those with privileged economic situations find it hard to cover all the expenses for the care, specialized advice, diet, and medicines right for them.

Depending on each unique management regimen, it is estimated that a person with type 1 diabetes can pay between 683 to 975 USD per month to manage their condition. The brands of insulin pumps that are available in Mexico are Medtronic and Accu-Check. People who decide to purchase a Medtronic insulin pump can pay up to 2,245 USD (depending on the model) for the device, and up to 200 USD per month for supplies. As for continuous glucose monitoring devices, people can purchase the FreeStyle Libre reader for 65 USD and sensors for 65 USD each.

In summary, diabetes is a very expensive condition in Mexico. For a person living with diabetes and their family, it means allocating a large percentage of their income to both the purchase of supplies and technologies as well as paying for specialized care, education and the monitoring of complications. Access to diabetes care varies widely and there are many disparities. The scenario becomes extremely devastating for those people who do not have a fixed job and income and/or who live in marginalized areas, where living with diabetes usually means a struggle to survive.

What about getting admitted to hospital?
In the Public Sector, hospital beds are completely insufficient. If you are lucky to get availability, admission will depend on the seriousness of the disease; hence, no bed is guaranteed in the Public Sector.

In the Private Sector, prior to getting admitted, an open voucher has to be signed as a warranty. The amount of this warranty will depend on the insurance level and seriousness of the disease. There are usually enough hospital beds in the Private Sector.

How does diabetes care vary throughout Mexico?
Mexico is 1.973 million square kilometers divided into 32 states with several differences of cultures, customs, dietary habits, education, income and, of course, public services. Capital cities are most likely to have access to health care related to diabetes; however this care is not enough.

Currently, there is no national census of persons with type 1 diabetes, but efforts are being made to do so, as well as to differentiate the different types of diabetes. In April 2021, the Congress of the Union and the Chamber of Deputies approved an addendum to the General Health Law on the prevention and differentiation of types of diabetes in order to visibilize type 1 diabetes, as well as to allocate the necessary and indispensable resources for both the diagnosis and the treatment of each type of diabetes. Behind this initiative comes the struggle of many voices and efforts of people with diabetes, their families, civil organizations and physicians. Despite these advances, creating awareness, efficient prevention campaigns, #insulin4all, and reachable diabetes education programmes is still a challenge for people with diabetes and those involved in its care.

Some individuals, associations and non-profit organizations working towards diabetes education and advocacy in Mexico:

• "Por una sola voz en la diabetes tipo 1" ("For a Single Voice in Type 1 Diabetes")
• Registro Nacional de Pacientes con Diabetes tipo 1 (RENACED) (The National Registry of Patients with Type 1 Diabetes)
• The Federación Mexicana de Diabetes, A.C o FDM (Mexican Diabetes Federation, A.C)
• The Asociación Mexicana de Diabetes (Mexican Diabetes Association)

Thank you to Manuel García Ortega and Angélica Luna Rodríguez Bueno for their independent contributions to this resource.