May I thank George Debono for his cordial and reasoned response to my letter about the prevalence of diabetes in Malta? We both agree that the prevalence of diabetes in Malta has been found to be 7.7 per cent among a population of over-15s in Antoine Schranz’s epidemiological study published in 1989.

That would be around 6.2 per cent standardised to the entire Maltese population, rather than just adults. Debono quotes a prevalence of 13.9 per cent, reported on the website of the International Diabetes Federation. This rate is calculated for those aged 20 to 79 and not for the entire adult population. As such, the total population prevalence figure would be significantly lower since the prevalence in children is lower. In the second instance, presumably the rate is calculated on data from the Maltese Diabetes Register, which is a cumulative register.

Data from such registers must be sampled according to a defined period of observation for an epidemiological study. To simplify, a cancer register that records all reported cases of cancer will always grow in size year in, year out, even though the prevalence of cancer could be stable or decrease. Two years ago, a more accurate point figure of 23,588 patients on the Diabetes Register in June 2014 was reported by Joseph Azzopardi. Thus, the figure of 44,000 Maltese diabetics on the IDF website is obviously wrong and by a huge margin.

The incidence and prevalence of diabetes were measured in an Electronic Health Indicator Data project for the European Commission and, again, the prevalence of diabetes mellituswas 6.25 per cent, standardised to a European Union standard population (EU15) early in the new millennium. The most recent estimate for the population prevalence of diabetes mellitus (type I and type II together, over a period of observation of five years from 2001 to 2005) was 5.9 per cent (standardised to the Maltese population in 2002), with an annual incidence of 0.5 per cent (non-standardised), published by myself in the international medical journal Family practice in 2012. The fact that the prevalence is 10 times the incidence indicates the prevalence of diabetes is stable.

Our most recent correspondence ended with a recommendation from the bicycle advocacy group where cyclists were encouraged to creatively ignore parts of the Highway Code on the strengths of similar dubious research.

I would suggest that since the use of helmets and cycle lanes are required of cyclists then we should not continue to argue the law but simply follow it.