With 135 million cases the prevalence of diabetes mellitus (DM) is very high worldwide. Diabetic nephropathy is a major complication of DM. In many countries diabetic nephropathy has become the most frequent cause of endstage renal disease. It is believed that in diabetic patients the creation of a native vascular access (NVA) might be difficult. We evaluated 274 occurrences of NVA creation during the period January 2003 to December 2008: 68 in diabetic patients (group 1) and 206 in nondiabetics (group 2). We compared the type of NVA, primary failure, and primary patency in these groups. Age was significantly higher in diabetic patients (68 vs 64 years; p < 0.05). No statistical differences in primary failure between groups were found for any NAV. Wrist vascular access survival rates were higher in diabetic versus nondiabetic patients (56.9% vs 20.7% at 72 months). No statistical differences were observed between groups in primary patency rates for middle- and upper-arm vascular access. According to our experience diabetes does not lead to additional difficulties in the creation of permanent vascular access, provided proper physical and instrumental examination is performed. Despite the advanced age of the diabetic patients in our study, wrist vascular access showed better results in this group than in nondiabetic patients on long-term follow-up.