Overview
According to data from the Statistical Yearbook of Health (2018), the prevalence of diabetes (type 1 and 2) in Cuba is 64.3 per 1,000 inhabitants. The age group with the highest prevalence is between 60 and 64 years of age, with 247.3 per 1,000 inhabitants, with women living mostly with this condition. Diabetes ranks eighth as a cause of death. The estimated rate is 21.1 per 100,000 inhabitants (2018).
In 1975, the National Institute of Endocrinology developed a National Comprehensive Diabetic Care Program, as well as Diabetic Care Centers. There are currently 18 Diabetic Care Centers throughout Cuba, as well as 19 diabetes and pregnancy services. Since its inception, the programme has been updated and refined through continuous evaluation. It covers three main lines of action: 1) training of health personnel for diabetes care and education; 2) diabetic education for people with diabetes and their relatives; 3) health education for the prevention of diabetes both in risk groups and in the general population. Diabetic education is considered the cornerstone of treatment and is given on a permanent basis.
What happens if you need to see a doctor?
In Cuba, the principles on which health care and coverage are based are: health as a human right, equity and solidarity. The National Health System (NHS) therefore provides comprehensive, universal, accessible, free and continuous care. People with a recent diagnosis or who arrive at the CAD and have a basic knowledge of diabetes management are taught between 6 and 8 sessions of basic diabetes information. The main objective is to sensitise and instruct the person with diabetes (and relatives) to face the therapeutic demands with a methodology “learning by doing” (demonstration exercises). Subsequently, a monthly or quarterly continuing education process is carried out (depending on educational needs). The objective is to strengthen people with diabetes in the development of skills, behaviours and decision making for their metabolic control.
The primary health care network is the main resource of services for the care of people with diabetes. Every person with diabetes is assigned to some centre where the consultations are conducted quarterly and include laboratory controls (A1c, 24-hour glycosuria, urine examination), check for complications (ocular, renal, neurological, vascular, dental). A retina examination, microalbuminuria and lipid profile tests are performed annually or in case of the presence of any symptom.
Who decides what medicines a doctor can prescribe?
The Ministry of Public Health (MINSAP) is responsible for directing, implementing and monitoring the implementation of State policies.
Practically, what is it like to live with Type 1 in Cuba?
In Cuba, the vast majority of people living with diabetes receive a glucometer. However, due to the economic and commercial blockade with the United States, the ability to acquire glucometers, strips, or state-of-the-art medications for type 1 and 2 diabetes is difficult. For every 12 hours that the borders are blockaded, 1 year’s worth of treatment doesn’t get through. Due to this same economic and commercial blockade, insulin pumps, continuous glucose monitoring sensors and the variety of analogous insulins are not available in Cuba. Depending on availability, the insulin delivered is NPH and rapid insulin. Another effect resulting from the commercial and economic blockade is the scarcity or unavailability of both basic drugs (analgesics, antimycotics, supplements, vitamins, etc.) and specialised drugs (type 1 and type 2 diabetes, antibiotics, etc.) in pharmacies and hospitals. The vast majority of people are forced to turn to the black market for medicines where the existence of all pharmaceuticals is not always guaranteed.
What about getting admitted to hospital?
The approach to patient care in Cuba is through the use of three levels of access to health care. In each Cuban community of approximately 100 families, a primary care doctor, usually a recent medical graduate, provides the first level (level I) of medical care. This physician, with access to medical supplies and drugs for treatment of common routine ailments, is to know and counsel families. They detect patients with significant disease(s) that require referral to specialists, provide education and preventive health care, and they assure that patients follow through with mandated health screening and health policy. Cuban published statistics note that 99.1% of their population is attended by medical doctors.
Access to the second level of care is provided by the polyclinics, which are smaller hospital facilities, in each province where specialists provide specialised care and have greater access to medications. Access to the third level of care is at the university hospitals of each of the 14 Cuban provinces and at the Cuban National Institutes of Health in Habana, where teaching and research takes place. Here the physicians have access to medication deemed essential for the survival of the patient, medications otherwise relatively unavailable.
How does diabetes care vary throughout the country?
In some regions, families face severe economic, food, housing, medicine and general resource scarcity and people with type 1 diabetes really struggle to access the basics (diabetes education, food, insulin, glucometer, syringes) to manage their condition.
Because of the commercial blockade between Cuba and the USA, the arrival and availability of medicine and resources, in general, is very scarce. People with type 1 diabetes have a lot of difficulties finding and accessing insulin and diabetes education. Human insulins are the only available but not always granted by the health care system. There is also the issue that people cannot choose a different glucometer than the one they were originally assigned.
In general the quality of medical attention is good but not as frequent as it should be. Food availability is also a concern for many families and there are not many sugar free options.
Last updated 2022