OBJECTIVE: To assess the predictive value of the metabolic syndrome in patients 
with type 1 diabetes.
RESEARCH DESIGN AND METHODS: Patients were from the prospective Finnish Diabetic 
Nephropathy (FinnDiane) Study (n = 3,783): mean age 37 +/- 12 years and diabetes 
duration 23 +/- 12 years. Metabolic syndrome was defined according to World 
Health Organization (WHO), National Cholesterol Education Program (NCEP), and 
International Diabetes Federation (IDF) definitions. Follow-up time was median 
5.5 years (interquartile range 3.7-6.7). Mortality data were complete, whereas 
morbidity data were available in 69% of the patients.
RESULTS: The WHO definition was associated with a 2.1-fold increased risk of 
cardiovascular events and a 2.5-fold increased risk of cardiovascular- and 
diabetes-related mortality, after adjustment for traditional risk factors and 
diabetic nephropathy. The NCEP definition did not predict outcomes when adjusted 
for nephropathy but markedly added to the risk associated with elevated 
albuminuria alone (P < 0.001). The IDF definition did not predict outcomes.
CONCLUSIONS: The metabolic syndrome is a risk factor, beyond albuminuria, for 
cardiovascular morbidity and diabetes-related mortality in type 1 diabetes.