AS National Diabetes Week highlighted last month, Australia is facing an epidemic of Type 2 (adult onset) diabetes. There are now nearly one million Australians with Type 2 diabetes. The problem will grow as the incidence of obesity increases, with 30 per cent of Australian children and 60 per cent of adults now overweight or obese. The rate of diabetes among overweight adolescents has jumped 16-fold in the last decade.

Diabetes costs the nation $3billion a year, of which $1billion is due to direct health costs, mostly for complications of diabetes such as heart disease, stroke, blindness and limb amputation. It has been estimated that each year more than $425million in hospital costs for these complications could be prevented by better access to community care.

However, current programs are inadequate, and now is the time to look for a more proactive approach that reaches out to people at risk of developing diabetes, ensures effective management of people with the disease, and recognises that those least able to access a doctor and afford the associated out-of-pocket costs disadvantaged, older and indigenous Australians are most likely to have diabetes and its complications.

The first problem is that half of all Australians who have diabetes have not been diagnosed. Almost one-quarter of the adult population has a condition of impaired glucose metabolism that is associated with an increases risk of diabetes. Family history and obesity contribute further to that risk. Unless these people walk into a doctor's office, and the doctor then orders the necessary tests, these people remain ignorant of their condition and how to treat it.

Recently, the Howard Government promised funding of $103million over four years for a new Medicare item under which GPs can develop a diabetes risk plan for their patients aged 40 to 49 years who are found to be at high risk. It is estimated that 136,000 Australians will participate in the program over the four years. Given the size of the problem, this is truly a Band-Aid approach.

Under the National Integrated Diabetes Program, general practitioners receive practice incentive payments if they provide a defined cycle of care to their patients with diabetes. Again this is a tiny program, funded at about $10million a year, funding levels which have not increased since the program was first introduced in 2002.

Busy doctors struggle to meet the paperwork requirements of the program and there is no mechanism to focus on those patients who are unlikely to return voluntarily for the required care. Only about a quarter of people enrolled receive the full cycle of care in any year. The consequences are that 30 per cent of people with diabetes are not getting treatment for high blood pressure when this is needed, 50 per cent have not had their feet checked by a podiatrist in the past year, and almost half have not been screened for eyesight problems in the past two years.

So it is no surprise that the rate of people being admitted to hospital for diabetes is increasing, the number of lower-leg amputations due to complications has not declined in a decade, and more than 86,000 people have a disability due to diabetes which is the cause or a related factor in 11,500 deaths every year.

New approaches that look for people at risk of diabetes in the workplace, in sporting venues and even in pubs are needed. Systems are required to ensure that diet, exercise, and medication regimes are followed and that there is regular follow-up and monitoring.

We need to know more about incentives and barriers to care from the perspectives of the health-care professional and the patient. And we need to know more about the impact of growing out-of-pocket costs on the ability of people with diabetes to manage their care.

These costs are currently estimated at between $2000 and $3000 a year about the same as the Government spends on each patient with diabetes through Medicare and the Pharmaceutical Benefit Scheme.

A health-care system that finds and treats people with diabetes and with risk factors for diabetes will certainly mean considerably more spending on Medicare, the PBS and the National Diabetes Services Scheme, but has the potential to save costs elsewhere, in hospital and welfare budgets.

Prevention and chronic disease management are today's buzz words. Translating words into effective national programs to address diabetes will require significant, long-term investments commensurate with the size of the problem.

Dr Lesley Russell is a research fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.