Abstract Objective: To verify the effects of metabolic syndrome (MS) and its relation to insulin resistance (IR) in children and adolescents with overweight or obesity after 24 months of follow-up. Design: Studies of repeated measures from April 2009 to April 2012. For both measurements, the evaluations performed were anthropometry, MS diagnosis, fasting blood glucose, glucose homeostasis model assessment (HOMA-IR), and insulin level; at a second evaluation, glycated hemoglobin (HbA_1c) was used as an additional indicator of glucose metabolism alterations. Logistic regression between syndrome persistence and its components with glucose metabolism alterations was performed for each of its indicators. The SPSS version 17.0 software (95% CI) was used. Location: Center for Childhood Obesity, Campina Grande, Brazil. Subjects: Children and adolescents (n=133), aged 2–18 years, with overweight or obesity. Results: There was a significant decrease in MS during the study period, with persistence of the syndrome in 17.3% of the individuals. The presence of at least one alteration in glucose metabolism occurred in 45.1% of children and adolescents. The systolic and diastolic blood pressure, and the average levels of HOMA-IR showed significant decrease at the end of 24 months (p<0.01), and an elevated waist circumference (WC) remained associated with IR (p<0.01). Conclusion: There was observed no relationship of IR or other indicator of glycemic disorders by persistence of MS. An elevated WC remained associated with IR after controlling for the effects of the following variables: gender, age group, and other MS components.