Insulin in our country México costs between 700-800 Mexican Pesos per vial (~40 USD). You would think that type 1 diabetes (T1D) management would be easier in a country where insulin does not seem as expensive as in other parts of the world. Yet, most families in Mexico still can’t afford it.

In Mexico, basic T1D treatment costs between 6K (320USD) and 10K (533USD) Mexican pesos per month. Only 3 out of 10 Mexicans earn more than 10K Mexican pesos (533USD) per month. This is not a good scenario for many of us.

In our country there are no type 1 diabetes statistics. We have no idea how many people with T1D there are. According to Mexican Diabetes Federation, we believe that between 2-5% of total cases of diabetes (10 million approximately) could be identified as type 1’s, but this is just an estimate.

Our health system is really complex. It is divided into two major schemes: Public and Private. The Public Sector includes: Mexican Social Security System (IMSS), Social Services and Security for Health Workers (ISSSTE), Petróleos Mexicanos (PEMEX), National Defense Department (SEDENA), Marine Department (SEMAR), State Clinics and Institutions and Seguro Popular. Seguro Popular was similar to universal health care, which is non-existent now since it was replaced by a new government by a new institute named INSABI, which began operations in January 2020. The second scheme is the Private Sector, which is expensive enough for it to be only accessible to a small percentage of our population.

Treatments for type 1 diabetes in México

Standards of care, Norma Oficial Mexicana NOM 015-SSA2-2010, exist for the prevention, treatment and control of diabetes. NOM-015 are the guidelines used to prescribe treatment and include basic information regarding detection, diagnosis, treatment, control, referral to specialists or different levels for T1D care. Standards of Care do emphasize glucose monitoring and different types of insulin. However, these are not provided through the health system.

The state, in theory, provides insulin, but you should know there’s a big chance insulin won't be available because of budget shortfalls. Insulins provided are mostly NPH and R and in some cases Lantus and Lispro. Not every patient who requires analogues will receive them. The state does DOES NOT provide any other tools: glucose meters, lancets, syringes. There are NO diabetes educators in the public health system unless pharma intervenes to provide free diabetes lessons and use of tools (glucose meters and others).

What happens with these families?

The truth is, even when there are no formal statistics, we know some children are not being diagnosed in time. DKA is causing deaths. When treatment is not provided by health system, all costs are out of pocket. Some families will not be able to afford insulin, meters and test strips.

Some families receive tools and basic supplies through Mexican Diabetes Federation which has 25 organizations in the country (glucose meters and test strips are provided through Life for a Child) but, as you might imagine a patchwork of 25 organizations are simply not enough to support all people with type 1 diabetes. If in Mexico City, people with diabetes can receive help from Asociación Mexicana de Diabetes. Sadly, these organizations cannot reach everyone and they rely and depend on fundraising which is a truly complicated thing to do in a country like ours.

Our efforts

Those of us privileged enough to afford our insulin cannot simply stand and see what is happening with our peers. We are aware of what is needed and have tried for many years to reach those who will decide on budgets and guidelines. We are also aware that we require training in advocacy to strengthen our efforts.

We are currently working in what we believe are our priorities:

1. Statistics: There are 2 different efforts underway both by non-profits in the diabetes space in Mexico
   -Renaced (lead by endocrinologists and medical society)
   -Por una Sola Voz (lead by patients and a big group of non-profits)
2. Social Movements: Por una sola voz en la Diabetes Tipo 1 is an Advocacy Movement created by people with diabetes and caregivers. They have are working campaigns and having meetings with government representatives and other. We cannot allow more people dying because of lack of treatments and correct diagnosis.
3. Public politics :Civil society is currently trying to meet with decision makers to increase the knowledge about all types of diabetes. We know that differentiation between types of diabetes as a starting point is important to determine diagnosis and treatments. We need specific treatment guidelines for type 1 diabetes as well as knowledgeable health professionals in our health system. We need urgent changes so that the treatment provided includes not only insulin, but devices to deliver insulin, devices to measure blood glucose and of course, diabetes education to provide skills and knowledge to use all these tools and to thrive living with diabetes.

These are the priorities we have identified:

• Timely and correct attention to type 1
• Distinction between different types of diabetes
• Obtaining National Statistics
• Reformulation of guidelines available
• Guarantee of timely distribution of supplies
• Training of our medical professionals

This movement’s objective is to influence public policies for the benefit of people living with T1D in this country. We need your help. We need to learn from diabetes advocates in other countries and from their experience to change the lives of others and learn tools to raise our voice to make change happen.We believe that we can be stronger together.

The authors can be contacted via Twitter at:

• Gisela Ayala: @AyalaGise
• Ricardo Mondragón: @Ricardomond
• Mariana Gómez: @dulcesitosmios