There are divergent criteria for the identification of metabolic syndrome (MetS), but all the definitions agree that obesity, insulin resistance, dyslipidemia and hypertension are core components of this syndrome. The MetS is associated with an increased risk of cardiovascular disease events in general populations. Well-designed prospective studies in Asian populations are very limited. This study characterizes nine parameters of the MetS in a population of diabetic patients without a history of cardiovascular disease in Bangladesh, and defines the influence of MetS on peripheral vascular disease. A total of 100 patients with diabetes who visited the outpatient department of BIRDEM for routine diabetic follow-up were included in this study. The prevalence of MetS was 66%. Sixty-seven percent of patients had a waist circumference above normal, 89% hypertriglyceridemia, and 87% a low HDL-C level, while elevated systolic blood pressure was found in 46% and diastolic blood pressure in 55%, according to IDF criteria. Peripheral vascular disease defined by a low ankle-brachial index (<0.9) was identified in 24% of patients with no history of a cardiovascular event.