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A good correlation between severity of metabolic syndrome (MetS) and HbA1c, fasting insulin and insulin resistance is reported. Consequently, the MetS seriousness score (or MestS Z-score) could possibly be used to predict the chance of T2DM progression with time. Aim To assess the association the of MestS Z-score in first-degree family members (FDRs) of T2DM using the risk of prediabetes and type 2 diabetes in the future. Practices A prospective open cohort research