As such, because most health care costs are borne by the patient in India, patients of public facilities are more likely to be low or middle income, uninsured, have low literacy, and be unable to afford insulin, blood glucose test strips, or advanced diabetes self-management technology; in contrast, patients of private facilities are more likely to be insured or have a level of income that affords private clinic consultation fees, analog insulin, and routine use of continuous glucose monitoring systems and insulin pumps. This evidence concerns the gene INS and diabetes mellitus.