Although there is no evidence of effectiveness of interventional trials concerning macroangiopathy in diabetes mellitus, the focus of primary prophylaxis is based on the treatment of risk factors and optimal adjustment of metabolic parameters. This should contain the prophylaxis of the diabetic foot (foot care, teaching, pressure bearing) in the neuro-ischaemic risk patient. In the secondary prophylaxis acetylsalicylic acid has been proven as effective in the cerebral, cardial, and peripheral vascular regions in different dosages. The aim of the symptomatic therapy is the improvement of the peripheral vascular disease symptoms, which could mean an improvement of the pain-free walking distance or the avoidance of an extremity-threatening ischaemic syndrome. The therapeutic range includes a structured exercise programme, conservative medical treatment, catheter procedures, and bypass surgery as well as amputation. The different procedures are mainly dependent on the general condition of the in many cases multimorbid patients, the clinical stage, the psychological burden and the angiologic status. There should be always an interdisciplinary discussion, which helps to find the right therapeutic decision. All the therapeutic activities should be seen under the guideline of an improvement in the quality of life.