Exosomes derived from mesenchymal stem cells (MSCs) show promise in treating diabetes and its complications due to their ability to modulate cellular processes and intercellular communication. This review summarizes the biological properties and potential applications of MSC-derived exosomes in diabetes management. MSCs-Exos have demonstrated comparable efficacy to MSCs in treating diabetes and its complications, offering advantages such as reduced immunogenicity, enhanced stability, and simplified storage. They can deliver therapeutic agents to specific cells and have been shown to improve insulin sensitivity, reduce inflammation, and promote tissue regeneration. MSCs-Exos from different sources, including bone marrow, adipose tissue, umbilical cord, and placenta, exhibit distinct biological functions and therapeutic effects. Research indicates that MSCs-Exos can protect β-cells, reduce insulin resistance, and enhance glucose homeostasis in both type 1 and type 2 diabetes. In diabetic complications, MSCs-Exos have shown potential in mitigating kidney disease, wound healing, and inflammation. They can suppress mesangial hyperplasia, promote podocyte repair, and reduce fibrosis. MSCs-Exos also enhance angiogenesis and tissue regeneration, which are critical for wound healing in diabetic patients. Despite these promising findings, challenges remain in optimizing MSCs-Exos for clinical application, including determining the optimal tissue source, enhancing their migratory capabilities, and improving administration routes. Further research is needed to fully harness the therapeutic potential of MSCs-Exos in diabetes and its complications.Exosomes derived from mesenchymal stem cells (MSCs) show promise in treating diabetes and its complications due to their ability to modulate cellular processes and intercellular communication. This review summarizes the biological properties and potential applications of MSC-derived exosomes in diabetes management. MSCs-Exos have demonstrated comparable efficacy to MSCs in treating diabetes and its complications, offering advantages such as reduced immunogenicity, enhanced stability, and simplified storage. They can deliver therapeutic agents to specific cells and have been shown to improve insulin sensitivity, reduce inflammation, and promote tissue regeneration. MSCs-Exos from different sources, including bone marrow, adipose tissue, umbilical cord, and placenta, exhibit distinct biological functions and therapeutic effects. Research indicates that MSCs-Exos can protect β-cells, reduce insulin resistance, and enhance glucose homeostasis in both type 1 and type 2 diabetes. In diabetic complications, MSCs-Exos have shown potential in mitigating kidney disease, wound healing, and inflammation. They can suppress mesangial hyperplasia, promote podocyte repair, and reduce fibrosis. MSCs-Exos also enhance angiogenesis and tissue regeneration, which are critical for wound healing in diabetic patients. Despite these promising findings, challenges remain in optimizing MSCs-Exos for clinical application, including determining the optimal tissue source, enhancing their migratory capabilities, and improving administration routes. Further research is needed to fully harness the therapeutic potential of MSCs-Exos in diabetes and its complications.