Abstract:This review discusses the role of microRNAs and exosomes in the pathogenesis and treatment of diabetes mellitus. MicroRNAs are a class of small RNA molecules consisting of 21 to 25 nucleotides, which play an important role in the regulation of gene expression. This review first introduces the synthesis and function of microRNAs, as well as their dysregulation in a variety of diseases. Next, the formation and composition of exosomes are explored and how they mediate intercellular communication by carrying specific microRNAs is explained. Besides, the secretion and roles of insulin as well as the pathogenesis of diabetes mellitus are analyzed. The microRNAs related to insulin secretion and glucose homeostasis are also discussed. Finally, the efficacy of two commonly used drugs, metformin and GLP-1 receptor agonists, in the treatment of diabetes mellitus, and their effects on microRNAs, pancreatic islet function, insulin resistance, and glucose homeostasis are summarized. This review aims to comprehensively elucidate the relationship between microRNAs, exosomes and diabetes mellitus, and to provide insights for novel therapeutic targets and strategies.