This review article explores the potential of mesenchymal stem cell-derived exosomes (MSCs-Exos) in treating diabetes and its complications. MSCs-Exos have emerged as promising candidates due to their ability to facilitate intercellular communication, modulate the local microenvironment, and regulate cellular processes. The article highlights the biological characteristics of MSCs-Exos, including their size, content, and heterogeneity, and discusses their therapeutic mechanisms in maintaining blood glucose homeostasis and treating diabetic complications such as diabetic kidney disease (DKD), diabetic cardiomyopathy (DCM), diabetic neuropathy, diabetic retinopathy, and diabetic wounds. MSCs-Exos have been shown to reduce inflammation, enhance insulin sensitivity, promote β-cell regeneration, and improve renal function in DKD. They also exhibit anti-inflammatory properties, enhance angiogenesis, and promote wound healing in diabetic patients. The review emphasizes the need for further research to optimize the use of MSCs-Exos in clinical settings, addressing challenges such as optimal tissue source selection, migration capabilities, and administration routes.This review article explores the potential of mesenchymal stem cell-derived exosomes (MSCs-Exos) in treating diabetes and its complications. MSCs-Exos have emerged as promising candidates due to their ability to facilitate intercellular communication, modulate the local microenvironment, and regulate cellular processes. The article highlights the biological characteristics of MSCs-Exos, including their size, content, and heterogeneity, and discusses their therapeutic mechanisms in maintaining blood glucose homeostasis and treating diabetic complications such as diabetic kidney disease (DKD), diabetic cardiomyopathy (DCM), diabetic neuropathy, diabetic retinopathy, and diabetic wounds. MSCs-Exos have been shown to reduce inflammation, enhance insulin sensitivity, promote β-cell regeneration, and improve renal function in DKD. They also exhibit anti-inflammatory properties, enhance angiogenesis, and promote wound healing in diabetic patients. The review emphasizes the need for further research to optimize the use of MSCs-Exos in clinical settings, addressing challenges such as optimal tissue source selection, migration capabilities, and administration routes.