A professor in human nutrition and medicine says the latest nationwide snapshot of diabetes has left him dumbstruck.
Each month, around 50 people lose a limb to the disease and New Zealand's current cost of treatment sits at more than $2.1 billion a year.
A PwC report commissioned by Diabetes New Zealand, the university of Otago's Edgar Diabetes and Obesity Research Centre and Healthier Lives National Science Challenge, predicts things are set to get a lot worse.
It claims the number of people with type 2 diabetes could rise by as much as 90 percent across the next two decades inflicting a "staggering" bill on taxpayers.
Almost a quarter of a million New Zealanders have type 2 diabetes and PwC estimates that within 20 years it could be as high as 430,000.
If numbers increase as the report suggests, treatment will cost $3.5b by 2041.
Key drivers are the country's ageing population, more young people getting diabetes and a growing population of ethnic minorities prone to the disease.
It's predicted that one in four Pasifika will have type 2 diabetes within the next two decades.
Healthier Lives National Science Challenge director Professor Jim Mann said the incidence rate of type 2 diabetes had reached epidemic proportions.
"I knew the situation was bad but I didn't realise how bad.
"I was absolutely dumbstruck when I saw the figures that they ended up with in terms of the cost and the difference in cost if you get diabetes at 25 and 70 so that really struck me."
Prof Mann said the most important part of the report is that increasing numbers and costs are preventable.
"I didn't realise how much of a difference we could make with treatments, we could prevent large numbers of people losing their limbs, we do have two new medicines which is great but we have a long way to go," he said.
Diabetes New Zealand chief executive Heather Verry said there was no national strategy on how to deal with diabetes.
"The government needs to take urgent action, it's not something that can be delayed in order to save the country millions of dollars and also to give those affected by diabetes a better quality of life."
She said the four recommendations in the report need to be adopted by the government including improving education around healthy eating and lifestyles.
Others are better diabetes medications and more foot screening and protecting to prevent serious foot related complications such as amputation.
Massey University college of health professor Pamela Von Hurst said there were too many people on the path to diabetes.
"This report confirms what dieticians and registered nutritionists already know so well - that a nutrition and lifestyle intervention, delivered by a qualified nutrition practitioner, can not only halt progression of a disease such as type 2 diabetes, but can often reverse it.
"Unfortunately, as the report explains, such effective interventions are not accessible to the people who need them the most. This inequity in service provision will result in an ever-increasing burden of disease in high risk populations until funding is directed towards early identification of risk and targeted, individual prevention strategies."
"Diabetes is a crisis right now"
TE ORA, the Māori Medical Practitioners Association, spokesperson Dr Jade Tamatea told Morning Report the size and proportion of the diabetes crisis affecting Māori and Pacific communities right now was a shock.
She said it was critical that the government takes this report on board and makes diabetes a priority.
"I think it hasn't been a priority for quite some time now and I guess the Covid response has really shown us what can happen when we make a public health issue a priority, we get the resources, we get the ability to respond to the needs of the community and we get a whole of system response to these health issues.
"I think diabetes is a crisis right now and the same sort of response is needed."
Dr Tamatea said the government needed to show strong leadership to address the inequalities the diabetes disease presents.
"Diabetes doesn't happen in a vacuum, we've created environments that breed diabetes.
"We have a high density of fast food, we have cities that have developed that make it unsafe to walk and cycle, we have high energy dense food that are cheaper than our fresh produce, so we need to make brave policies that actually protect our communities, like eliminating sweetened beverages within our schools, policies that actually make a difference for our communities.
"But equally, we can't ignore the wider determinants of health and the impact that has on diabetes prevalence. We know that those living with limited resources, those that have issues with food security and those that can't get access to good quality health that proactively manage diabetes, those are the ones that are going to get hit the hardest ... when we have a one size fits all response, which has been the classic response to date, our Pacific communities, our Māori communities are not going to respond to the exact same response and they need an individualised, more appropriate approach."
In response, Health Minister Andrew Little told Morning Report that diabetes was a priority for the government and that it investing in long-term initiatives for Māori and Pacific population.
"The point I think is that the way we deliver a lot of our health services is through the DHBs, that's the health delivery model that we've got in this country, so we can set up an initiative but where it comes to delivery we're reliant on what happens at DHBs."
Little said the government was also embarking on health reforms to try meet its objectives.
"If you look at the Health and Disability System Review report that came out last year which called for measures to achieve greater consistency and coherence across the system, so that reform programme is under way, the announcements are a few weeks away yet.
"Right now we have a diabetes challenge and we've got what we've got with the system we have and we've got to try and make that work and we are."