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Figure 2 Interrelations and overlap of metabolic syndrome with insulin resistance, prediabetes, and type 2 diabetes. According to the insulin resistance hypothesis, the metabolic syndrome is caused predominantly by insulin resistance. The latter also contributes to prediabetes and, ultimately, to type 2 diabetes. About 75% of people with prediabetes and 86% of people with type 2 diabetes have the metabolic syndrome. Both metabolic syndrome and type 2 diabetes are known to predict cardiovascular disease.