OBJECTIVE: To compare the blood pressure and metabolic parameters of type 2 diabetic patients with high waist circumference (WC) with those of type 2 diabetic patients with normal WC. DESIGN: After 10-14 h overnight fasting, weight, height, waist and hip circumferences and blood pressure were measured, and blood samples taken for glucose, glycated haemoglobin, total cholesteroL triglyceride, HDL-cholesterol, LDL-cholesterol and insulin determinations. Insulin resistance was calculated using the homeostatic model assessment (HOMA) method, while high WC was considered as WC > 102 cm and 89 cm for males and females, respectively. SETTING: Two primary care clinics in Trinidad, West Indies. PATIENTS: 190 confirmed type 2 diabetic patients with mean duration of 9.2 years were studied. RESULTS: About 75% and 17% of female and male patients, respectively, had high WC. Although blood pressure and lipid levels did not differ (p > 0.05) between patients with high and normal WC, the former group of patients had significantly higher mean levels of basal insulin and insulin resistance in each gender group (p < 0.001). However, female patients had an overall higher prevalence rate of hypercholesterolaemia (75% vs 52%) and higher LDL-cholesterol (84% vs 68%) than male patients (p < 0.001). CONCLUSIONS: Although there was similarity in the control of blood pressure and metabolic parameters irrespective of WC, patients with high WC might be at a comparatively higher risk of cardiovascular disease owing to greater basal insulin resistance. Early detection and treatment of abdominal obesity should therefore be encouraged in the primary healthcare setting.