The Invisible Burden of Type 1 Diabetes in Mexico
Written by Karina Wallrafen-Sam, Business Development Intern at HFI; graphic designed by Cassidy Wang, Communications Intern at HFI
In Mexico, Type 2 Diabetes (T2D) is widely recognized as a serious public health issue — it’s now the leading cause of death in Mexico and is expected to pose an even greater burden in coming decades. But while the severity of T2D is well-acknowledged in Mexico, Type 1 Diabetes (T1D) is frequently overlooked there; data on T1D’s prevalence, health impacts, and economic burden in Mexico is limited and often contradictory. Julissa Rolon, a T1D Patient Advocate based in Guadalajara, recently lamented that “living in Mexico with T1D is like being invisible. No one knows how many of us live with this disease, and it seems like not a lot of people care.” To shed light on this overlooked issue, this post outlines T1D data and treatment gaps, the economic and political implications of neglecting T1D, and ongoing efforts to proactively address T1D in Mexico.
T1D Data Gaps in Mexico
Until 2012, most data about T1D in Mexico came from a study conducted in a single state, Veracruz, that happened to have a very low incidence rate (0.6 new cases per 100,000 inhabitants), leading to the widespread misperception that T1D is not a problem in Mexico the way it is in many other countries. Since then, incidence registers from the Mexican Institute of Social Security have placed the incidence rate of T1D as of 2018 at 2.8 new cases per 100,000 publicly insured subjects younger than 20 — which is mid-range compared to other countries. In 2019, the International Diabetes Federation (IDF) Diabetes Atlas reported a prevalence of 26,578 T1D cases among children and youths in Mexico (which is about 59.6 cases per 100,000 people under age 20). This is likely an underestimate; the overall prevalence of T1D in Mexico is still unknown and the IDF estimates that almost 40% of the adult diabetic population there is undiagnosed. Additionally, information about the long-term outcomes of those with T1D is sorely lacking. The RENACED-DT1 registry is attempting to fill that information gap1, but as of 2018, it had enrolled only about 6% of people with known diagnosed cases of T1D in Mexico, which highlights the difficulty of gathering comprehensive information.
T1D Treatment Gaps in Mexico
The majority of people with T1D enrolled in the RENACED-DT1 registry are not reaching their treatment targets. Most have poor glycemic control and many suffer from acute or chronic complications, such as diabetic neuropathy (a type of nerve damage), diabetic retinopathy (damage to the eyes), and diabetic nephropathy (kidney disease). In Mexico, people with T1D visit the emergency room and are hospitalized very frequently — in one study, 39% of participants with T1D visited the ER at least once and 33.9% were hospitalized due to diabetes-related complications during the year-long study period. Chronic complications, emergency room visits and hospitalizations, and poor glycemic control have all been found to be more common among T1D patients in Mexico than in other countries, from Denmark to Scotland to Peru. (In those three countries, the proportion of T1D patients with hospital admissions is in the 20–28% range, compared to 33.9% in Mexico.) Furthermore, reviews of the RENACED-DT1 registry have found that T1D patients treated in public healthcare settings have both a lower probability of achieving treatment goals and a higher risk of developing chronic complications than patients treated in private healthcare settings: for example, only 14.9% of patients in the registry receiving public healthcare had an HbA1c level (an indicator of average blood glucose concentration) below the target value of 7%, compared to 20.4% of those receiving private healthcare, which the researchers found to be a statistically significant difference after adjusting for age, time since diagnosis, BMI, and other variables. Since the majority of T1D patients receive public healthcare, such disparities highlight how social inequality impacts the quality of care received by T1D patients in Mexico.
Economic and Political Implications of Neglecting T1D in Mexico
The growing prevalence of diabetes is placing a strain on both the Mexican economy — due to the rising costs of healthcare and diabetes-related disability pensions — and on the country’s healthcare system, with diabetes now being the second most common reason for primary care clinic visits. Since many people living with T1D receive suboptimal treatment for years and the proportion of patients with chronic complications is high, those who can afford it seek care with private endocrinologists and bear the burden of high out-of-pocket costs. Even for those receiving public healthcare, government coverage for T1D treatment is limited and out-of-pocket expenses are considerable. In theory, the state provides insulin, but budget shortfalls mean that not all patients have reliable access to it; and even those who receive it are on their own for the other tools they need, such as glucose meters and syringes. As a result, in Mexico, each person diagnosed with diabetes can expect to spend up to about 3.70 USD per day on diabetes care (as of 2019). The 2019 minimum wage in Mexico was 6.00 USD per day — so diabetes-related expenses account for more than 60% of a minimum wage earner’s salary. It is not surprising, then, that 55% of the population with diabetes in Jalisco, Mexico fails to manage their condition, according to data from the State Health Secretary in 2020.
Efforts to Proactively Address T1D in Mexico
To prevent complications and improve their quality of life, those with diabetes require universal insulin access, continuous monitoring, assessment for both acute and chronic complications, and education about their condition. Studies have found that new technologies — such as continuous subcutaneous insulin infusion with an insulin pump — can enable patients to achieve glycemic control and avoid diabetic complications. Real-time continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG) at least 4 times a day are associated with improved glycemic control, in Mexico as in other countries, while infrequent SMBG is associated with microvascular complications — which highlights the importance of access to medical devices for glucose monitoring. One recent study also found that effective diabetes education impacts a patient’s likelihood of achieving their treatment goals and can mediate some of the risks conferred by a public healthcare setting, illustrating the importance of emphasizing diabetes education strategies.
People living with T1D — in Mexico and elsewhere — require proper acknowledgment of their condition and equitable access to care to survive and thrive. That’s why the Health Finance Institute (HFI) is working to launch its first series of innovative finance instruments to stimulate the research, development, and mass production of affordable life-saving glucose monitoring devices for children and youth in selected under-resourced countries — beginning with a pilot program in Jalisco, Mexico. By piloting this program in Jalisco, we intend to make the invisible visible and the interventions replicable. Upon reflecting on HFI’s work, Julissa Rolon said “…hearing what HFI intends to do brings me joy and hopefulness that kids and teenagers could have a shot at a higher quality of life.” You can support HFI’s efforts to increase access to life-saving medical devices by donating here.