The world is currently in the midst of a diabetes epidemic which has not shown any sign of waning. As more people have diabetes and suffer complications, the disease burden will undoubtedly increase. Macrovascular complications e.g. coronary artery disease, cerebrovascular disease and peripheral arterial disease are common among people with diabetes. Cardiovascular diseases are a significant cause of mortality in people with diabetes. Among the microvascular complications nephropathy is a leading cause of end stage renal disease while retinopathy is among the most common causes of visual impairment or blindness. The pathogenetic pathways of diabetic complications are the polyol pathway, formation of advanced glycation end products, protein kinase C activation and recently the hexosamine biosynthetic pathway. These hyperglycemia induced pathways act both individually and in concert to generate intermediaries e.g. growth factors, adhesion molecules, cytokines etc. which are involved in tissue damage. The occurrence of these complications has extensive geographical variation as is the collective effort to prevent or manage them which often depends on the socioeconomic standard and the commitment of the region involved. Appreciating the reality of the threat posed by diabetes complications would enable concerned bodies make well informed decisions on the appropriation of healthcare resources and also make healthcare providers and patients intensify efforts in working together towards preventing these complications.