Exosomal microRNAs (miRNAs) are a class of non-coding single-stranded RNAs mediated by exosomes, which can change protein expression after transcription by inhibiting the translation of messenger RNA. In diabetes, alterations in the coding regions of genes lead to changes in the expression of miRNAs, which induce a series of pathophy-physiological changes such as oxidative stress, mitochondrial dysfunction, myocardial apoptosis and pyroptosis, vascular remodeling, fibrosis, and then participate in the occurrence and development of diabetic heart disease. This paper reviews the characteristics of exosomal miRNAs, and their therapeutic potential in diabetic heart disease.