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Abstract Diabetes poses severe global public health problems and places heavy burdens on the medical and economic systems of society. Type 2 diabetes (T2D) accounts for 90% of these cases. Diabetes also often accompanies serious complications that threaten multiple organs such as the brain, eyes, kidneys, and the cardiovascular system. MicroRNAs (miRNAs) carried by extracellular vesicles (EV‐miRNAs) are considered to mediate cross‐organ and cross‐cellular communication and have a vital role in the pathophysiology of T2D. They also offer promising sources of diabetes‐related biomarkers and serve as effective therapeutic targets. Here, we briefly reviewed studies of EV‐miRNAs in T2D and related complications. Specially, we innovatively explore the targeting nature of miRNA action due to the target specificity of vesicle binding, aiding mechanism understanding as well as the detection and treatment of diseases.