Background: Diabetes is associated with increased risk of a large number of complications including microvascular and macrovascular diseases, blindness, some cancers, gallstones and all-cause mortality. Objective: The aim of the research is to study the prevalence of macrovascular complications among rural and urban diabetic patients in Sohag Governorate, Upper Egypt. Methods: This Study was conducted in Sohag Governorate as cross sectional study on diabetes mellitus in Upper Egypt. The study included 500 diabetic patients randomly selected from various cities and villages (rural and urban) of Sohag Governorate. all patients were subjected to: history taking, clinical examination, blood pressure and pulse evaluation, ECG, echocardiography and laboratory investigations including blood glucose and HbA1c estimation. Results: 500 diabetics patients included in then study, 239 from rural areas and 261 from urban areas. No statistically significant difference between patients from urban and rural areas as regard age, gender and smoking while body mass index was higher in patients from urban areas. Both groups were badly controlled on anti-diabetic medications. The prevalence of HTN was higher in rural than urban. The prevalence of IHD and diastolic dysfunction were higher in urban than rural areas with significant difference. The prevalence of stroke was nearly equal and the prevalence of PAD was higher in rural with no significant difference. Conclusion: Macrovascular complications are prevalent among diabetic patients either from rural or urban residence. Ischemic heart disease and diastolic dysfunction is significantly prevalent among urban diabetic patients than rural ones.