Diabetes in Cayman: dialysis, amputations and the semaglutide data

Two late-stage complications of diabetes, kidney failure and limb loss, are shaping recent investment by the Cayman Islands Health Services Authority (HSA). In August 2025 the HSA opened a dialysis unit at West Bay Health Centre so patients no longer have to travel to George Town several times a week²³. In November 2025 it announced that vascular surgery services had been reintroduced, with a focus on amputation prevention and dialysis access¹. For physicians, both moves point to the same population: people whose diabetes was found late or controlled poorly.

Dialysis capacity in the Cayman Islands

According to the HSA, the dialysis unit at the Anthony S. Eden Hospital can treat up to 13 patients at a time and dialyses an average of 33 to 39 patients a day; Faith Hospital on Cayman Brac has one chair, and the new West Bay unit adds two machines and two chairs²⁴. The HSA reports a crude mortality rate in chronic haemodialysis of 8.45% for 2020⁴. HSA nephrologist Dr. Ikechi Okpechi said the new facility "will greatly benefit both existing and future patients"². West Bay has the second-highest number of dialysis patients in the islands, and the HSA held its 2026 World Kidney Day screening at West Bay Health Centre, offering blood pressure, blood sugar and urine checks⁶.

Vascular surgery and amputation prevention

HSA vascular surgeon Dr. Steven Richardson says the most common conditions he treats locally are peripheral artery disease, diabetic foot complications, varicose veins and dialysis access problems, and that diabetes, high blood pressure and high cholesterol are leading causes of vascular disease in the islands¹. "Diabetes damages both small and large blood vessels, reducing blood flow and sensation in the legs and feet," he said, adding that "most amputations can be prevented through early vascular assessment and revascularisation"¹. On dialysis, he noted that "Reliable access to the bloodstream is essential for dialysis"¹.

The gaps start earlier. Citing the STEPS 2023 National Health Survey, the HSA reports that 10.8% of adults have been diagnosed with raised blood sugar or diabetes, 23.6% have never had their blood sugar checked, and half of those living with diabetes have never had a foot examination¹⁵. Globally, a meta-analysis put the prevalence of diabetic foot ulcers at 6.3% of people with diabetes, highest in North America at 13.0%¹⁰. When STEPS findings were released, the then Chief Medical Officer said "The cost, or fear of the cost, of health care is now a major barrier to many people"⁷.

What the semaglutide kidney and artery trials show

GLP-1 drugs are usually discussed for weight, but two recent trials speak directly to the complications the HSA is treating. In FLOW, 3,533 people with type 2 diabetes and chronic kidney disease were randomized to semaglutide or placebo for a median of 3.4 years. The primary composite outcome of major kidney events was 24% lower with semaglutide (HR 0.76; 95% CI 0.66 to 0.88; 331 vs 410 first events), the annual decline in eGFR was 1.16 ml/min/1.73 m² slower, and all-cause death was 20% lower (HR 0.80)⁸. In STRIDE, 792 people with symptomatic peripheral artery disease and type 2 diabetes received semaglutide or placebo; after 52 weeks the estimated treatment ratio for maximum walking distance was 1.13 (95% CI 1.06 to 1.21)⁹.

These are trials of an approved medicine in defined patients, not evidence for any other peptide product. The Pan American Health Organization asked countries in March 2026 to restrict GLP-1 use to "indications approved by the national regulatory authority", warning that demand is driving sales through unofficial channels, where products may be "falsified, unauthorized, or substandard", and listing acute pancreatitis, gallbladder disease and intestinal obstruction as less common but potentially serious risks¹¹.

What it means for physicians in the Cayman Islands

The practical messages are basic but urgent: screen for diabetes in the quarter of adults never tested, examine feet, check kidney function, and refer early¹⁶. Access can depend on insurance. Under the current system, most CINICO members other than those on a Standard Health Insurance Contract need a referral approved by the Chief Medical Officer to see providers outside the HSA; a 2026 pilot giving CINICO's own employees direct access to Health City Cayman Islands and Doctors Hospital aims to collect data before any wider extension¹². The FLOW and STRIDE results add kidney and limb outcomes to the evidence on semaglutide in type 2 diabetes⁸⁹.