OBJECTIVES: Assessing risk profiles and medical optimisation potentials (MOP) for diabetics participating in a German diabetes management (DM) project. METHODS: Medical record data from privately insured type-2 diabetics participating in a DM project were used to calculate individual 10-year-probabilities of complications with a Markov-chain based disease model (Mellibase). MOPs are the relative risk difference when comparing present individual risk versus risk of a patient achieving national guideline values for key risk factors (HbA1c, systolic blood pressure (SBP), total cholesterol, HDL cholesterol, triglycerides, smoking status). MOPs were communicated to patients and their physicians using Mellibase reports. Assessments are repeated after 3 and 6 months. RESULTS: Of 178 type-2 diabetics (mean age 58 years, diabetes diagnosed since median 7 years, 8% females) 97/85% had at least one risk factor at medium/high level according to guideline. A total of 15/29/28/28% of the diabetics shows 0/1/2/=3 risk factors at a high level. A total of 43% of participants exhibit a MOP for retinopathy of at least 40%. MOPs for myocardial infarction, stroke, foot amputation and renal failure were 25/15/25/17%. For each 100 DIAMART diabetics with 1/2/=3 risk factors at high level the MOPs are equivalent to 5/11/23 less expected events over 10 years, reflecting the enormous opportunity for improvement. First 3 months follow-up data (80 diabetics) indicate significant reductions for HbA1c, SBP, and total cholesterol among high risk patients. CONCLUSIONS: Diabetics participating in DIAMART at the start are at high risk for complications, resulting in substantial MOP. First follow-up data suggest that MOPs, when used by the physician via Mellibase reports to inform and motivate the patient, could be an effective tool to motivate for reaching recommended guideline risk levels by translating risk into opportunities. For DM planning MOPs quantify potential benefits from specific interventions (e.g. anti-smoking initiative) in diabetes care and help focusing efforts on improving outcomes.