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Temesgen Bizuayehu Wube,1 Metsihet Mohammed Nuru,2 Adane Tesfaye Anbese3 1School of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia; 2Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia; 3Department of Public Health, School of Public Health, College of Medicine and Health Science, Dilla University, Dilla, EthiopiaCorrespondence: Temesgen Bizuayehu WubeSchool of Medical Laboratory Science, College of Medicine and Health Sciences, Hawassa University, P.O. Box:1560, Hawassa, EthiopiaTel +251 916604551Email temesgenbizuayehu2@gmail.comBackground: Recognition of MetS in type two diabetic patients is important in starting the appropriate preventive and therapeutic measures. The commonly used definitions of MetS have similarities and discrepancies. Different definitions defined metabolic syndrome differently. IDF, WHO, NCEP-ATP III, and the harmonized definitions were used frequently to determine the prevalence of metabolic syndrome.Objectives: This study was aimed to investigate the prevalence of MetS and its associated factors among patients with type 2 Diabetes Mellitus using four definitions and to identify the concordance and the difference of these four definitions.Methods: A cross-sectional study was conducted from February 28 to May 30/2017 at Hawassa university comprehensive specialized hospital. The study involved 314 study participants selected by simple random sampling technique. Logistic regression was used to determine associated factors of metabolic syndrome, and kappa statistics was used to determine the concordance between different definitions of metabolic syndrome. In any cases, a p-value of |