Diabetes has emerged as a critical global health issue, with its associated complications posing a severe threat to patients' quality of life. Current research demonstrates that imbalance in mitochondrial dynamics and autophagic dysregulation play pivotal roles in the pathogenesis of diabetic complications, particularly in diabetic cardiomyopathy, nephropathy, peripheral neuropathy and retinopathy. Strategic modulation of mitochondrial function and autophagic activity represents a promising therapeutic approach for managing diabetic complications. Furthermore, integrating mitochondrial dynamics and autophagy, we have outlined the application prospects of strategies related to diabetic complications, including mitochondrial fission inhibitors, autophagy inducers, and certain compounds extracted from traditional Chinese medicines, and incorporated new breakthroughs in mitochondrial imaging, omics, and artificial intelligence-based therapeutic prediction. This review systematically examines the intricate relationship between diabetic complications and dysregulations in mitochondrial dynamics and autophagic dysfunction, while elucidating the underlying molecular mechanisms, and highlights the significance of mitochondrial dynamics and autophagy in diabetic complications. Imbalances in mitochondrial dynamics-whether abnormal fission or fusion-and autophagic dysregulation do not exist in isolation. A comprehensive understanding of the interplay between diabetic pathophysiology and the mitochondrial-autophagy axis may provide novel research perspectives for therapeutic development. This paper provides a comprehensive review of the literature to clarify the above content, using a narrative review approach. Future investigations should prioritize translational exploration to harness the clinical potential of these mechanistic insights, thereby advancing precision medicine strategies for the management of diabetic complications.