Cohort Profile: The Fremantle Diabetes Study

When the Fremantle Diabetes Study (FDS) Phase I was conceived in 1991 by its chief investigator (T.M.E.D.), there were few published longitudinal community-based diabetes natural history studies. Population studies such as Framingham in the United States and Busselton in Australia contained relatively small subgroups from which limited additional diabetes-specific information was collected. The United Kingdom Prospective Diabetes Study (UKPDS) had recruited more than 5000 newly diagnosed type 2 subjects aged 25–65 years but the sample, although relatively large, was not community based. The diagnosis of diabetes was based on a low fasting plasma glucose concentration (>6 mmol/l), and the study was interventional with outcomes presented in 1998. There were also Australia-specific aspects of diabetes that had not been characterized in detail, especially the disproportionately large number of patients from a migrant (especially Southern European) background and the important question of diabetes in indigenous groups. The aim of FDS Phase I was, therefore, to identify from all potential sources, and collect detailed prospective data from, known diabetic patients in a stable multi-ethnic urban Australian population to examine clinically relevant aspects of diabetes including clinical management, metabolic control, complications and cost. Based on the amount of available seeding funding from the Raine Foundation, University of Western Australia (WA) and respecting a reasonable patient time commitment and throughput, it was decided to attempt to recruit all consenting patients from the Fremantle Hospital (FH) primary catchment area, a postcode-defined population of approximately 120 000 living in and around the port of Fremantle in Western Australia. A 3-year registration period between 1993 and 1996 was followed by yearly reviews of the FDS Phase I cohort until 2001 (a minimum follow-up of 5 years) by which time more than half of the patients had died or withdrawn, although acquisition of hospitalizations, cancer registrations …