One in four Australians with diabetes don't know they have the disease.
Of those who are aware they have type 2 diabetes, half aren't managing it properly.
There are particular concentrations of type 2 diabetes among poorer communities and older Australians.
However, younger adults were worse at managing the disease.
Many needed to do more to maintain a healthy weight, manage blood pressure and quit smoking.
And the COAG Reform Council is worried the increasing numbers of overweight and obese Australians will lead to even more people suffering from diabetes.
Council chairman John Brumby says an increase in people with diabetes translates to high health costs, especially if sufferers need dialysis have limbs amputated or go blind.
"This unambiguously, unarguably is going to be a big challenge for governments," he told reporters on Wednesday.
"It's going to put more cost on the health system, on the hospital system, on families, on workplaces, on taxpayers."
For the first time, the council has used blood samples to gather data on diabetes in Australia, which is more accurate than asking people if they have the disease.
Over the past five years, governments around Australia have made no progress towards their goal of boosting the number of people with a healthy body weight.
At the same time, the proportion of people who were overweight or obese rose.
Now in a group of 12 Australians, three would be obese and another four overweight.
It was easy to forecast from that an increase in heart attacks, strokes and diabetes, Mr Brumby said.
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