Delayed wound healing is a major complication of diabetes, significantly impacting patients' quality of life. Traditional treatments, such as wound debridement, dressing application, and growth factor therapy, often suffer from limited efficacy and significant side effects. In recent years, exosomes have emerged as a promising therapeutic strategy for promoting diabetic skin wound healing. Exosomes, nano-sized vesicles secreted by cells, are rich in bioactive components, including proteins, nucleic acids, and lipids, enabling them to participate in intercellular communication and modulate cellular functions. Studies have demonstrated that exosomes derived from stem cells can significantly enhance diabetic wound healing. This effect is attributed to their ability to modulate key wound healing processes, including shortening the inflammatory phase, promoting angiogenesis, facilitating cell migration and re-epithelialization, and regulating collagen remodeling. Moreover, various pre-treatment strategies, applied to either the exosome-secreting cells or the isolated exosomes themselves, can significantly augment their therapeutic efficacy. As natural nanocarriers with low immunogenicity and high targeting specificity, exosomes hold great promise in tissue repair and regenerative medicine. This review summarizes the latest research progress on exosomes in diabetic wound healing, exploring their mechanisms of action and potential clinical applications, thereby establishing a foundation for the clinical translation of exosomes in diabetic wound management.