Acceso a terapias para la diabetes en Bolivia: avances, brechas y desafíos

Diabetes mellitus remains one of the major challenges facing the Bolivian healthcare system. In recent years, new therapeutic options and technologies for the management of type 1 and type 2 diabetes have become available, including insulin analogues, continuous glucose monitoring systems, and antihyperglycemic agents with proven cardiovascular, renal, and metabolic benefits. However, the incorporation of these advances has not been uniform, and access continues to be influenced by the organization of the healthcare system, differences in health coverage across subsystems, and the economic constraints faced by many patients. The coexistence of the Unified Health System (Sistema Único de Salud, SUS), the social security system, and the private healthcare sector creates a complex landscape in which the availability of medications, supplies, and diabetes technologies does not always translate into equitable access. Variations in healthcare coverage, medicine supply, service capacity, and resource distribution limit the implementation of international guideline recommendations and contribute to significant disparities in diabetes care. This lecture will provide an overview of the current landscape of access to diabetes therapies and technologies in Bolivia, including insulin, continuous glucose monitoring, and newer antihyperglycemic agents. Differences among the country's healthcare subsystems will be examined together with the main barriers related to medicine supply, financing, healthcare coverage, and geographic inequalities, and their impact on daily clinical practice. Strategies aimed at improving the availability, accessibility, and continuity of diabetes care will also be discussed. The Bolivian experience offers an opportunity to place these challenges within the broader Latin American context and to identify priorities for advancing more equitable, sustainable, and patient-centered diabetes care.