T2DM stands as one of the most prevalent chronic diseases globally, with an increasing incidence, notably associated with obesity. While its pathophysiology remains incompletely understood, it is primarily linked to insulin resistance, resulting in reduced glucose uptake by the liver, muscles, and adipose tissue, consequently leading to elevated blood glucose levels. Classical clinical features of T2DM include polydipsia, polyuria, and polyphagia, yet many patients are asymptomatic, underscoring the importance of screening, particularly in obese individuals with a positive family history. Diagnosis of T2DM currently relies on assessing levels of FPG, OGTT, and HbA1c. A myriad of glucose-lowering medications are available in the market today. Poorly controlled T2DM is associated with numerous complications, such as diabetic retinopathy, neuropathy, nephropathy, cardiomyopathy, and impaired wound healing. EVs are released by various cells and categorized into three types based on size: apoptotic bodies, microvesicles, and exosomes, in ascending order. Recent research has underscored the pivotal role of extracellular vesicles, particularly exosomes, in the physiology and pathophysiology of various diseases, including T2DM. Exosomes, small vesicles facilitating intercellular communication, have been shown to contribute to the pathophysiology of T2DM and its complications. Despite ongoing investigations, much remains to be elucidated regarding exosomes. However, they hold immense promise in the realm of theranostics—integrated therapeutic and diagnostic approaches—particularly concerning T2DM complications. Continued research into exosomes has the potential to unveil novel diagnostic tools and therapeutic strategies, revolutionizing the management and treatment of T2DM and enhancing patient outcomes.