Exosome-derived microRNAs（miRNA）are a class of non-coding single-stranded RNA secreted by exosomes，which alter protein expression by inhibiting the translation of messenger RNA. In diabetes，alterations in the coding regions of genes lead to changes in miRNA expression. These variations induce a series of pathophysiological changes，such as oxidative stress，mitochondrial dysfunction，myocardial apoptosis and pyroptosis，vascular remodeling，and fibrosis，thereby participating in the occurrence and development of diabetic heart disease. This article reviews the characteristics of exosome-derived miRNAs and summarizes their roles and therapeutic potential in diabetic heart disease.