The objective was to study the influence of parental history of type 2 diabetes mellitus on prevalence of the metabolic syndrome (MS) and other cardiometabolic risk factors in Asian Indian adolescents. Adolescents aged 12 to 19 years (N = 321) were recruited from the Chennai Urban Rural Epidemiology Study. Based on parental diabetic status, 3 groups were studied: group 1, offspring of parents with normal glucose tolerance (n = 105); group 2, offspring of 1 diabetic parent (n = 114); and group 3, offspring of 2 diabetic parents (n = 102). Subjects underwent blood pressure and anthropometric measurements as well as an oral glucose tolerance test and a fasting lipid profile. Metabolic syndrome was diagnosed using the International Diabetes Federation definition. Body mass index (P < .001) and waist and hip circumference (P < .05 for group 2 and P < .001 for group 3) were significantly higher in groups 2 and 3 compared with group 1. High-density lipoprotein cholesterol was significantly lower in groups 2 and 3 compared with group 1 (P < .05). Serum triglycerides were significantly higher in group 3 (P < .05) compared with the other 2 groups. Adolescents in group 3 (P < .001) and group 2 (P < .05) were significantly more overweight and had more abdominal obesity compared with those in group 1. Impaired fasting glucose and impaired glucose tolerance were also significantly higher in group 3 compared with the other 2 groups. High blood pressure showed an increasing trend from group 1 to group 3 (P for trend < .05). Two metabolic abnormalities were present in 7.6%, 14.9%, and 22.5% of adolescents in groups 1, 2, and 3, respectively (trend chi(2): 9.04, P = .003). Prevalence of MS was higher in groups 2 and 3 compared with group 1 but did not reach statistical significance because of small numbers. The cardiometabolic profile of the parents was similar to that of the adolescents. Parental history of type 2 diabetes mellitus increases risk of not only glucose intolerance but also other cardiometabolic risk factors like overweight, low high-density lipoprotein cholesterol, and high blood pressure in Asian Indian adolescents.