“In lieu of flowers, memorial donations may be given to JDRF,” Nicole Smith-Holt wrote in the 2017 obituary for her son Alec Smith, who died at twenty-six from insulin rationing. In his memory, she went on to form a fifty-person team for a fundraising walk for the nonprofit, formerly known as the Juvenile Diabetes Research Foundation. “At the time, we were under the illusion that they actually advocated for people with diabetes,” Smith-Holt, who now works as an advocate for another group, T1International, reflected over Zoom five years later. Today, since learning more about the largest diabetes nonprofits, she says, “I would not give them a penny.”

JDRF and the American Diabetes Association (ADA) are practically synonymous with experience of the disease itself. Patients are introduced to JDRF and its mission — “Improving lives today and tomorrow by accelerating life-changing breakthroughs to cure, prevent and treat T1D [type 1 diabetes] and its complications” — as early as diagnosis. The group, which focuses on medical research, hosts summits and walks that are especially popular with children and their families looking for community.

Many of its programs are funded by corporate sponsors, including between $2 and $5 million annually from insulin manufacturers. The ADA, which describes its mission as improving the lives of those living with diabetes and educating the public, receives at least $2.5 million annually from these companies.