This study investigates the role of adipose tissue macrophages (ATMs) in mediating the insulin-sensitizing effects of rosiglitazone (Rosi), a thiazolidinedione drug. Rosi treatment in obese mice improves glucose and insulin tolerance, reduces inflammation, and increases the polarization of ATMs towards an anti-inflammatory phenotype. ATM-derived small extracellular vesicles (ATM-sEVs) from Rosi-treated obese mice are shown to enhance insulin sensitivity in adipocytes, myotubes, and primary mouse hepatocytes. The beneficial metabolic effects of Rosi-ATM-sEVs are attributed to the release of miR-690, which targets the *Nadk* gene, promoting insulin signaling and glucose-stimulated insulin secretion (GSIS). In vivo administration of Rosi-ATM-sEVs rescues obesity-induced glucose intolerance and insulin resistance without the adverse side effects of weight gain or haemodilution associated with thiazolidinedione use. The findings suggest that ATM-sEV-miR-690 may provide a therapeutic approach to induce insulin sensitization without the typical side effects of thiazolidinediones.This study investigates the role of adipose tissue macrophages (ATMs) in mediating the insulin-sensitizing effects of rosiglitazone (Rosi), a thiazolidinedione drug. Rosi treatment in obese mice improves glucose and insulin tolerance, reduces inflammation, and increases the polarization of ATMs towards an anti-inflammatory phenotype. ATM-derived small extracellular vesicles (ATM-sEVs) from Rosi-treated obese mice are shown to enhance insulin sensitivity in adipocytes, myotubes, and primary mouse hepatocytes. The beneficial metabolic effects of Rosi-ATM-sEVs are attributed to the release of miR-690, which targets the *Nadk* gene, promoting insulin signaling and glucose-stimulated insulin secretion (GSIS). In vivo administration of Rosi-ATM-sEVs rescues obesity-induced glucose intolerance and insulin resistance without the adverse side effects of weight gain or haemodilution associated with thiazolidinedione use. The findings suggest that ATM-sEV-miR-690 may provide a therapeutic approach to induce insulin sensitization without the typical side effects of thiazolidinediones.