Australia is spending billions treating diabetes. Prevention keeps losing.

What just happened

The numbers are familiar to anyone working in chronic disease, but seeing them assembled in one place still lands with some weight. Professor Anna Peeters, Chief Executive Officer of VicHealth, has published a commentary in The Medical Republic that makes a blunt argument: Australia keeps finding better ways to treat diabetes while the conditions that produce it go largely unchanged.

The headline data: approximately 1 in 15 Australians has diabetes. In 2023–24, diabetes was linked to 1.3 million hospitalisations and $4.4 billion in health system costs. These are not stable numbers — the trajectory is upward, and it is steep.

The sharpest figure is the one on gestational diabetes. Gestational diabetes affected nearly one in five women who gave birth in Australian hospitals in 2023–24 — up from 9.3% in 2012–13. In a decade, the rate has more than doubled. And women in disadvantaged areas were 1.6 times more likely to be diagnosed with gestational diabetes than women in more advantaged areas. That gradient is not random variation. It names something about the structure of the problem.

Both-and

The limits of medicine as the primary response

GLP-1 receptor agonists — semaglutide (Ozempic, Wegovy), tirzepatide, and related medicines — represent a genuine therapeutic advance. For high-risk patients, they reduce progression from pre-diabetes to type 2 diabetes, produce meaningful weight loss, and have demonstrated cardiovascular benefit. General practice is incorporating them into diabetes management, and the evidence base for that is solid.

Professor Peeters’ argument is not that these medicines are wrong. It is that medicine is reaching what she calls “the limit of medicine” as a prevention strategy. Prescribing a GLP-1 to an individual high-risk patient is appropriate clinical care. It does not change the food environment that produced their risk, the income constraints that shaped their diet, the housing instability that disrupted their sleep and activity, or the neighbourhood factors that determined what was cheapest and most available to eat.

Only 6.5% of Australian adults meet recommended daily vegetable intake. That is not a result of widespread ignorance about vegetables. It reflects cost, access, time, and the relative affordability of ultra-processed food compared to fresh produce in many Australian communities.

The food environment question

The VicHealth analysis describes modelling from Melbourne’s west that found if 51,000 young children in the region ate one additional serve of vegetables daily, the long-term healthcare savings could reach $182 million. That is a local example of a national logic: the metabolic health of a population is significantly shaped by what it can affordably, routinely eat — and that is a food systems and economic conditions problem, not a personal choice problem.

This is territory general practice can acknowledge without resolving. A GP in a disadvantaged area cannot prescribe affordable fresh food. They can, however, hold the system framing alongside the individual one — understanding that a patient’s diet is embedded in a set of structural conditions, and that advice to “eat more vegetables” lands differently depending on what’s available and affordable.

The gestational diabetes signal

The gestational diabetes numbers deserve specific attention from anyone seeing women of reproductive age in general practice. Nearly one in five pregnant women in Australia now carries a gestational diabetes diagnosis. That is a substantial proportion of pregnancies, and it carries downstream implications — for the pregnancy itself, for postpartum metabolic risk in the mother (women with gestational diabetes have significantly elevated lifetime risk of type 2 diabetes), and for metabolic risk in the offspring.

The 1.6× disadvantage gradient tells a story about antenatal care access, diet quality during pregnancy, pre-pregnancy weight, and structural stressors — all of which cluster in disadvantaged populations. For general practice, preconception care and early pregnancy support represent an intervention point that sits upstream of the gestational diabetes diagnosis — and one where conversations about nutrition, weight, and metabolic risk can happen without the acute pressure of a pregnancy already in progress.

What prevention actually requires

Professor Peeters is direct about the mismatch: [“the limit of medicine”] is treatment, not the socioeconomic conditions that produce disease. The $4.4 billion in diabetes hospitalisations is spent downstream of decisions — about food subsidies, urban planning, housing, income support — that sit well outside the health portfolio.

The commentary argues for investment in population prevention that addresses structural drivers, not just individual behaviour. School nutrition programs, food affordability policies, neighbourhood design — these are not traditional health system tools, but they are the tools that shift population metabolic risk at scale.

From a clinical perspective, this doesn’t mean waiting for policy change to have useful conversations. It means holding the structural context alongside the individual consultation — understanding that someone’s 30-year dietary pattern reflects more than their choices, and that advice is most useful when it accounts for what is actually achievable in their circumstances.

My two cents

The doubling of gestational diabetes rates in a decade is a number that should be on general practice’s radar — not just as a clinical screening question (though it is that), but as a signal about population-level metabolic health trends that are going to keep producing more complex patients.

For women in their forties, the preconception and early pregnancy metabolic risk conversation has particular relevance. Gestational diabetes risk increases with age. Women who’ve had gestational diabetes in a previous pregnancy carry meaningfully elevated lifetime type 2 diabetes risk. These are conversations worth initiating, not waiting for symptoms to prompt.

The broader argument — that Australia treats disease more than it prevents it — is not new, and it tends to get the acknowledgement due a structural problem while remaining structurally unaddressed. The VicHealth analysis at least puts specific numbers on the gap.

Verdict: yes — the gestational diabetes rate and equity gradient are clinically significant, and the structural prevention argument deserves attention in how GPs understand individual metabolic risk.

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Sources cited

1. What stops us from preventing diabetes? Professor Anna Peeters, Medical Republic, 25 August 2026. https://www.medicalrepublic.com.au/what-stops-us-from-preventing-diabetes/128445