Many diabetics are taking steps sufficient to manage but not halt the gradual worsening of their disease, and they're the ones Kevin Rudd wants to keep out of the nation's hospitals.
The prime minister's plan would see GPs paid $1200 for every diabetic they can sign up to their practice, with more money on offer should they then turn a patient's declining health around.
The initiative, announced this week against a backdrop of negotiation with the states over a claw-back of public hospital funding control, would begin from 2012 at a cost of $436 million.
Professor Lesley Campbell said that while the jury was out on many aspects of the plan, there was a clear need to tackle diabetes "out in the community ... where the problems are".
"The problem is we're facing what people call an epidemic of diabetes," said Professor Campbell, director of the Diabetes Unit at Sydney's St Vincent's Hospital.
"There are going to be more patients to treat than we have ever had. This will be a partial stimulus to getting some of those treated optimally."
The plan aims to make diabetics more likely to see a single "home" GP, and that GP would take on an enhanced role in overseeing their condition and organising referrals, where needed, to specialist help such as a dietician or physiotherapist.
The initial $1200 pays for the GP to create a personalised care plan for their diabetic patient, and to provide them with ongoing support to stick to this plan.
Participating clinics would be eligible for around $10,800 a year in performance bonuses if the diabetics under their care could be shown to be meet some as-yet undisclosed health criteria.
Prof Campbell said it was apparent that GPs would need a lot of support from specialist services if they were to achieve the health gains sought.
And while an incentive payments for GPs may raise eyebrows, it could also be seen as a payment now that would avert higher costs later.
"It is worthwhile to stop someone who has diabetes and a couple of problems from losing their foot," Prof Campbell said.
"It is also better than the dramatic thing of putting $50,000 in to save somebody who is in a terminal state.
"This is acting earlier in the piece."
Diabetes is a factor in many cases of heart disease and stroke, and it can also lead directly to a range of ill health including gum disease and blindness, lower limb amputation and kidney failure.
The problem of under-treated diabetes can stem from a diabetic person's inability to make the necessary lifestyle and diet changes, or a reluctance to take the literal fistful of pills needed to keep their blood sugar, cholesterol and blood pressure at acceptable levels.
Prof Campbell said some diabetics also appeared to have "bad luck" that would ensure their condition was "on a downward path" and their vital signs would continue to post unhealthy "numbers".
"It often comes out that only two-thirds of (diabetic) patients ever get to anything like the right numbers," she said.
Diabetes is the nation's fastest growing chronic disease with an estimated 275 people newly diagnosed with the condition every day.
More than three million Australians are now estimated to either have diabetes or be in the process of developing it.
If the level of care these people receive in the community can be improved then it is hoped fewer will go on to need extended or acute hospital care.
As to whether the federal government's plan or any community-focused diabetes initiative can achieve this, Prof Campbell said, it was a case of wait and see.
"I think this is a start and giving money to something certainly helps," she said.
"... At least, it will have been tried."
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