INTRODUCTION: Little is known about the burden of diabetes and related conditions among urban Indigenous Australians. The DRUID study was established to address this important information gap. SUBJECTS: Eligible participants were Aboriginal and Torres Strait Islander adult volunteers aged 15 years and over who had lived in a defined region in and around Darwin, NT for at least 6 months. MATERIALS AND METHODS: Participants underwent a health examination based on the AusDiab protocol, including blood and urine collection, clinical and anthropometric measurements and questionnaires, in 2003-2005. RESULTS: Among 861 participants included in the analysis (approximately 14% of the target population), diabetes and other cardiovascular risk factors were common and increased with age. Almost one-third of those aged >or=35 years (31.7%) and over half of those >or=55 years (52.4%) had diabetes. Of 48 participants with newly diagnosed diabetes, half would not have been diagnosed without OGTT. Cardiovascular risk factors were common even among young people without diabetes-45% had >or=2 risk factors and only 18% had none. CONCLUSIONS: This study indicates a very high burden of current disease and high risk of future disease, even among young people. Both primary prevention and better management of known risk factors and existing disease are urgently required.