Diabetes is generally associated with vasculopathy, which contains both microvascular and macrovascular complications, associated with high morbidity and mortality. Currently, despite interventional therapy, the overall prognosis for patients with diabetic vasculopathy remains unsatisfactory. Angiogenesis and vascular injury and repair are associated with a variety of cells. However, the molecular mechanisms of the cells that are involved in pathogenesis of diabetic vasculopathy remain largely unknown. As novel molecules, microRNAs (miRs) take part in regulating protein-coding gene expression at the post-transcriptional level, and contribute to the pathogenesis of various types of chronic metabolism disease, especially diabetic vasculopathy. This allows miRs to have a direct function in regulation of various cellular events. Additionally, circulating miRs have been proposed as biomarkers for a wide range of cardiovascular diseases. This review elucidates miR-mediated regulatory mechanisms in diabetic vasculopathy. Furthermore, we discuss the current understanding of miRs in diabetic vasculopathy. Finally, we summarize the development of novel diagnostic and therapeutic strategies for diabetic vasculopathy related to miRs.