A Policy Analysis on the Proactive Prevention of Chronic Disease: Learnings from the Initial Implementation of Integrated Measurement for Early Detection (MIDO)

Document Type : Policy Brief


1 Fundación Carlos Slim, Mexico City, Mexico

2 Eli Lilly and Company, Lilly Global Health, Geneva, Switzerland

3 Lilly NCD Partnership, Indianapolis, IN, USA

4 Lilly NCD Partnership, Mexico City, Mexico

5 C230 Consultores, Mexico City, Mexico


Mexico, like many low- and middle-income countries (LMICs), faces an epidemic of chronic non-communicable diseases (NCDs), specifically diabetes, hypertension, obesity, and lipid disorders. Many people with these NCDs may not be aware that they have a disease, pointing to the need for broader screening programs. The traditional prevention policy in Mexico was based on screening with a paper-based risk factor questionnaire. However, this was used to screen patients already seeking healthcare services at facilities, and screening goals were set as a function of the number of questionnaires applied, not number of individuals screened. Due to this, Fundación Carlos Slim developed Medición Integrada para la Detección Oportuna (MIDOTM), or Integrated Measurement for Early Detection, an NCD screening and proactive prevention policy.

This document is a policy analysis based on early learnings from the initial implementation of MIDO in eight primary healthcare centers in two central Mexican states.

MIDO was found to expand screening programs beyond clinic walls, systematize community screening strategies, emphasize the detection of pre-disease phases, incorporate lifestyle counseling, and propose screening goals based on population targets. In collaboration with the Mexican Ministry of Health, MIDO has successfully screened over 500 000 individuals—about 40% of whom would not have been screened under previous policies. Of these more than 500 000 screened individuals, 13.4% had pre-diabetes (fasting glucose between 100 and 125 mg/dL), and 5.8% had undiagnosed diabetes (defined as fasting glucose above 126 mg/dL or random glucose above 200 mg/dL). However, there is still room for improvement in linking positive results from screening with disease confirmation and with patient incorporation into disease management. The experience of implementing MIDO in Mexico suggests that primary and secondary prevention programs in other parts of the world should consider the need for population-based screening targets, a greater focus on pre-disease stages, and the streamlining of the transition between screening, confirmation of diagnosis, and incorporation of patients into the healthcare system.




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Main Subjects



  1. International Diabetes Federation. IDF Diabetes Atlas. http://www.diabetesatlas.org/. Published 2015.
  2. Hu FB. Globalization of diabetes: the role of diet, lifestyle, and genes. Diabetes Care. 2011;34(6):1249-1257. Doi:10.2337/dc11-0442
  3. Goetzel RZ. Do prevention or treatment services save money? The wrong debate. Health Affairs. 2009;28(1):37–41.
  4. Nugent R. Chronic diseases in developing countries. Ann N Y Acad Sci. 2008;1136(1):70-79. Doi:10.1196/annals.1425.027
  5. Aguilar-Salinas C, Velásquez-Monroy O, Gomez-Perez F, et al. Characteristics of the patients with type 2 diabetes in México: results from a large population based, nation-wide survey. Diabetes Care 2003:26:2021-2026.
  6. Olaiz-Fernández G, Rivera-Dommarco J, Shamah-Levy T, et al. Encuesta Nacional de Salud y Nutrición 2006. Cuernavaca, México: Instituto Nacional de Salud Pública; 2006. http://ensanut.insp.mx/informes/ensanut2006.pdf.
  7. Gutierrez J, Rivera-Dommarco J, Shamah-Levy T. Encuesta Nacional de Salud y Nutrición 2012, Resultados Nacionales. Cuernavaca, México: Instituto Nacional de Salud Pública; 2013. http://ensanut.insp.mx/informes/ENSANUT2012ResultadosNacionales.pdf.
  8. Tapia-Conyer R, Gallardo-Rincón H, Saucedo-Martinez R. CASALUD: an innovative health-care system to control and prevent non-communicable diseases in Mexico. Perspect Public Health. 2015;135(4):180-190.
  9. Secretaría de Salud. Programa de Acción: Diabetes Mellitus. Mexico City: Secretaria de Salud; 2001. http://www.salud.gob.mx/unidades/cdi/documentos/diabetes_mellitus.pdf.
  10. Villalpando S, de la Cruz V, Rojas R, et al. Prevalence and distribution of type 2 diabetes mellitus in Mexican adult population: a probabilistic survey. Salud Pública de México. 2010;52:S19-S26.
  11. Tapia-Conyer R, Velazquez-Monroy O, Lara-Esqueda A, et al. Guia de Detección Integrada de Obesidad, Diabetes e Hipertensión Arterial. Mexico; 2002. http://www.salud.gob.mx/unidades/cdi/documentos/DOCSAL7482.pdf.
  12. Barquera S, Campos-Nonato I, Aguilar-Salinas C, et al. Diabetes in Mexico: cost and management of diabetes and its complications and challenges for health policy. Globalization and Health. 2013;9:3. Doi:10.1186/1744-8603-9-3
  13. Pandve H. Changing concept of disease prevention: From primordial to quaternary. Arch Med Health Sci. 2014; 2(2):254.
  14. McClellan M, Tapia-Conyer R, Thoumia A, et al. Preventing Chronic Disease through Innovative Primary Care Models. Center for Health Policy at Brookings; 2015. http://www.brookings.edu/~/media/research/files/papers/2015/04/07-global-accountable-care/mexico--casalud-final.pdf.  Accessed June 24, 2016.
  15. Estrategia Nacional para la Prevención y el Control del Sobrepeso, la Obesidad y la Diabetes. Mexico City: Secretaria de Salud; 2013. http://promocion.salud.gob.mx/dgps/descargas1/estrategia/Estrategia_con_portada.pdf.
  16. Fundación Carlos Slim. Tablero de Control de Enfermedades Crónicas. Redes de Excelencia en Diabetes (RED). http://oment.uanl.mx/tablero-de-control-de-enfermedades/.  Accessed December 10, 2016. Published 2016.
  • Receive Date: 30 August 2016
  • Revise Date: 08 January 2017
  • Accept Date: 08 February 2017
  • First Publish Date: 01 June 2017