How Diabetes Got To Be The No. 1 Killer In Mexico

Apr 5, 2017
Originally published on April 12, 2017 3:00 pm

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Mario Alberto Maciel Tinajero looks like a fairly healthy 68-year-old. He has a few extra pounds on his chest but he's relatively fit. Yet he's suffered for the last 20 years from what he calls a "terrible" condition: diabetes.

"I've never gotten used to this disease," he says. Maciel runs a stall in the Lagunilla market in downtown Mexico City. This market is famous for its custom-made quinceañera dresses and hand-tailored suits.

Diabetes has come to dominate Maciel's life. It claimed the life of his mother. He has to take pills and injections every day to keep it under control.

And because of the disease he's supposed to eat a diet heavy in vegetables that he views as inconvenient and bland. "Imagine not being able to eat a carnitas taco!" he says with indignation. His doctors have told him to stop eating the steaming hot street food that's for sale all around the market — tacos, tamales, quesadillas, fat sandwiches called tortas. His eyes light up when talks about the roast pork taquitos and simmering beef barbacoa that he's supposed to stay away from.

"A person who has to work 8 or 10 hours has to eat what's at hand, what's available," he says. "It's difficult to follow a diabetic diet. The truth is it's very difficult."

Diabetes is the leading cause of death in Mexico, according to the World Health Organization. The disease claims nearly 80,000 lives each year, and forecasters say the health problem is expected to get worse in the decades to come. By contrast, in the U.S. it's the sixth leading cause of death, with heart disease and cancer claiming 10 times more Americans each year than diabetes.

Rising rates of obesity combined with a genetic predisposition for Type 2 diabetes has caused a slow steady rise in the condition in Mexico over the last 40 years. Now roughly 14 percent of adults in this country of 120 million are living with what can be a devastating and even fatal health condition. Diabetes poses an increasing burden on the nation's hospitals and clinics. The surge in diabetes threatens the very stability of Mexico's public health care system, according to new reports.

For many people with diabetes in Mexico, like Maciel, managing the condition is a constant and significant challenge.

"I'd say I have it about 50 percent under control," he says, even though he was diagnosed two decades ago. "I take my medicine. I inject my insulin twice a day, in the morning and the night. I try to eat a proper diet as much as I can."

At times he says he can't afford his medications. And trying to cut down on the amount of sugar, salt and fat in his diet, as his doctors tell him he should, is easier said than done.

And Maciel's experience helps explain how Type 2 diabetes has become the leading cause of death in Mexico.

Type 2 diabetes is often considered a lifestyle disease because it's far more likely to develop in people who are overweight. Mexico has seen a rapid increase in obesity, with the number of people categorized as overweight and obese tripling over the last four decades.

The obesity problem is in part a side effect of Mexico's economic progress. As wages have risen, the average daily intake of calories has soared. In 2012 Mexico was the world's top per capita consumer of soda in the world guzzling 176 liters per person per year, according to the Mexican government. That's nearly 500 cans of soda for every man, woman and child. (Mexico was recently overtaken by Argentina, the U.S. and Chile.) Coca-Cola is practically the national drink in Mexico. Type 2 diabetes has skyrocketed as soda consumption has risen.

"In the middle of the 1970s and especially after the '80s, the prevalence of diabetes exploded," says Dr. Carlos Aguilar Salinas, the vice head of the endocrine department at Mexico's National Institute of Medical Sciences and Nutrition in Mexico City.

"Diabetes is now one of the biggest problems in the health system in Mexico," he says. It's the first cause of death. It's the first cause of disability. It's the first cause of early retirement. It's the main cost for the health system."

Diabetes costs the Mexican health care system billions of dollars each year.

The disease can lead to serious eye problems including blindness, nerve damage that requires amputations and kidney failure, among other issues.

Mexico's public health care system attempts to manage the huge number of people with diabetes by trying to get them to manage their blood sugar levels, alter their diet and exercise more.

But there diabetes is typically a lifelong condition. Once someone is diagnosed, the goal is to get the disease under control and keep it from getting worse.

Just around the corner from where Mario Alberto Marciel Tinajero has his dress-making shop, Dr. Rosa Estrella Calvillo Gomez runs a one-room medical clinic in the Lagunilla market.

The free clinic was set up by the local government. People can come in for any kind of health problem. But Calvillo says roughly half her patients are coming for complications with diabetes.

"Diabetics don't just come in with high blood sugar," Calvillo says sitting behind a desk overflowing with promotional drug samples that she gets from pharmaceutical representatives. "It's about controlling multiple health problems at once," she says, and most of her patients with diabetes don't have the disease under control.

"The problem that I have here first, is the denial and second, the cost of the medication."

Patients don't want to accept that they have a disease for which there is no cure. "Tell me anything but don't tell me that I'm a diabetic,'" she says they tell her. She melodramatically puts her hands over her eyes and shakes her head. "They deny it."

Also, diabetes isn't an easy condition to manage. The public health system treats severe complications like nerve damage or blindness, although dialysis and kidney transplants are not available. For the daily management of diabetes, patients are largely on their own.

Calvillo says a diabetic can easily spend $150 a month out of pocket on insulin injections, blood sugar test strips and medications for hypertension and other complications.

"To get excellent control of diabetes costs a lot of money," she says, "It costs as much as renting an apartment."

Mario Alberto Maciel Tinajero is one of the doctor's patients. He says coping with the disease is a real struggle, and many people with diabetes are desperate.

"The most dangerous thing for diabetics is to fall into the hands of charlatans, swindlers who offer miracle products," he says.

As diabetes took its final toll on his mother, he watched as she spent thousands of pesos on useless — he thinks possibly even toxic — herbs and injections. After both her feet had been amputated and doctors were only offering palliative care, salesmen came along offering "magical" injections, alleging that they'd give her relief.

"With the promise of a cure, you can be left in the street with nothing," he says. "Absolutely nothing."

Maciel is grateful to have Dr. Calvillo to help him grapple with the condition.

"If this clinic didn't exist," he says, "I would be dead."

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KELLY MCEVERS, HOST:

Mexico is facing a health crisis. Diabetes now kills more Mexicans each year than any other disease. For many of the 11 million Mexicans who now have diabetes, managing the condition is a constant challenge. NPR's Jason Beaubien reports.

JASON BEAUBIEN, BYLINE: The Lagunilla Market near the center of Mexico City is famous for its handmade clothes. In the crowded stalls, tailors sew elaborate quinceanera dresses, and they make custom suits for formal parties. Mario Alberto Maciel Tinajero is one of those artisans. Taking a break from tending his shop, he's sitting in a senior center in the interior of the market.

MARIO ALBERTO MACIEL TINAJERO: (Speaking Spanish).

BEAUBIEN: "I've been a diabetic for 20 years," Maciel says. And the disease has come to dominate his life. His mother lost both her feet to diabetes and eventually died from it. His grandson recently had a foot amputated because of the condition. Two decades after being diagnosed with diabetes, the 68-year-old Maciel admits that he only has the condition partially under control.

MACIEL: (Through interpreter) I say 50 percent because I take my medicine. I inject my insulin twice a day in the morning and the night. I try to eat a proper diet as much as I can.

BEAUBIEN: But he says at times he can't afford his medications, and trying to cut down on the amount of sugar, salt and fat in his diet as his doctors tell him he should is easier said than done. His doctors with fancy degrees from Spain or the United States don't understand the life of ordinary Mexicans, he says.

MACIEL: (Through interpreter) For a person who has to work eight or 10 hours, he has to eat what's readily available.

BEAUBIEN: And what's readily available around this market are small stands offering tacos, quesadillas, lard-soaked tamales, soft drinks and juices loaded with sugar. His eyes light up as he talks about the rich roast pork taquitos, the simmering barbacoa and the other foods that he's not supposed to eat.

MACIEL: (Through interpreter) It's difficult to follow a diabetic diet. The truth is it's very difficult.

BEAUBIEN: And this is at the heart of how Type 2 diabetes has become the leading cause of death in Mexico. In the U.S., it's the sixth-leading cause of death with heart disease and cancer claiming 10 times more Americans each year than diabetes. Mexico, however, has seen a rapid increase in obesity over the last four decades with the number of people being characterized as overweight and obese tripling.

As Mexicans' average daily intake of calories has soared, Type 2 diabetes has skyrocketed, too. Currently 14 percent of Mexican adults are believed to have the disease, which is one of the highest rates in the world, higher than even in the United States.

ROSA ESTRELLA CALVILLO GOMEZ: (Speaking Spanish).

BEAUBIEN: Inside the senior center at the Lagunilla Market, Dr. Rosa Estrella Calvillo Gomez runs a one room medical clinic. She sits behind a desk overflowing with drug samples, small packets of medications and bottles of pills.

CALVILLO: (Speaking Spanish).

BEAUBIEN: She says treating diabetes is about far more than just curtailing high blood sugar. It's about controlling multiple health problems at once, and she says most of her diabetic patients don't have the disease under control.

CALVILLO: (Through interpreter) The real problem that I have here, first, is the denial and, second, the cost of the medications.

BEAUBIEN: Patients don't want to accept that they have a disease for which there is no cure. Also it's not an easy condition to manage. The public health system treats severe complications like nerve damage or blindness. Although dialysis to treat kidney failure is not available.

For the daily management of diabetes, however, patients are largely on their own. Dr. Calvillo says a diabetic can easily spend $150 a month out of pocket on insulin injections, blood sugar test strips, medications for hypertension and other issues.

CALVILLO: (Speaking Spanish).

BEAUBIEN: "To get control of diabetes costs a lot of money," she says. "It costs as much as renting an apartment." Mario Alberto Maciel Tinajero, the dressmaker we met earlier, is one of Dr. Calvillo's patients. He says coping with the disease is a real struggle, and many diabetics are desperate.

MACIEL: (Through interpreter) The most dangerous thing for diabetics is to fall into the hands of charlatans and swindlers who offer these miracle products.

BEAUBIEN: As diabetes took its final toll on his mother, he watched as she spent thousands of pesos on useless - he thinks - possibly even toxic herbs and injections. After both her feet had been amputated and doctors were only offering palliative care, salesmen came along, offering magical injections that would give her relief.

MACIEL: (Through interpreter) With the promise of a cure, you can be left in the street with nothing, absolutely nothing.

BEAUBIEN: Diabetes is a terrible disease, he says, and he's grateful to have Dr. Calvillo to help him manage it.

MACIEL: (Speaking Spanish).

BEAUBIEN: "If it wasn't for the free care at this clinic," Maciel says flatly, diabetes would have killed him a long time ago. Jason Beaubien, NPR News, Mexico City. Transcript provided by NPR, Copyright NPR.