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Estimating the prevalence of diagnosed diabetes in a health district of Wales

We welcome the comments of Drs Gill and Beeching [1] concerning our recent paper [2]. As stated, we accept that the estimate of prevalence is likely to be an underestimate but is signi®cantly greater than other estimates for our population. We deemed capture±recapture (CR) techniques to be inappropriate primarily because the chance of appearing on the secondary care source was not random but dictated partly by the severity of the disease. Therefore the application of CR to our data is likely to overestimate the actual prevalence of diagnosed diabetes in our population. Nonetheless, we accept that our ®gures do represent an underestimate and a true ®gure approximating 3.0% as suggested by Gill and Beeching, based on the application of CR techniques to our data and a reference to their own work in Liverpool and that of Bruno et al. in Italy, is feasible. (Incidentally, it should be noted that the data in Fig. 3 are based on maximum migration rather than the application of migration rates.) Our estimate of 2.3% is considerably higher than that generally quoted, and if a ®gure of 3.0% is indeed more realistic then this is almost double the average ®gures reported in recent years. This has major implications for the planning of health services in light of an ageing population, and it is perhaps remarkable that for a disease that indirectly accounts for nearly 10% of secondary care expenditure so little is known about its prevalence.