Background: Microvascular complications are a major concern for patients with Type 2 Diabetes Mellitus (T2DM). The impact of glycemic control on these complications remains a pivotal area of research.Methods: This prospective cohort study enrolled 1200 patients with T2DM,assessing the effects of glycemic control on the incidence and progression of nephropathy, retinopathy, and neuropathy over five years. Glycemic control was monitored by quarterly measurements of HbA1c.Results: Improved glycemic control was associated with a decrease in the development of microvascular complications.Specifically, the incidence of nephropathy and neuropathy decreased significantly with better control of HbA1c (OR = 0.85, p=0.01 and OR = 0.75, p<0.001, respectively). The study also noted a 20% decrease in the risk of retinopathy (OR = 0.80, p=0.002). These associations held true across various age groups, with more pronounced benefits in patients over 50 years. Conclusion: Effective management of blood glucose levels is crucial for preventing microvascular complications in T2DM. The findings advocate for individualized treatment plans to achieve optimal glycemic control, thereby enhancing outcomes and reducing complications.