Diabetic cardiomyopathy (DCM) refers to a complication that arises in diabetic patients and leads to various cardiac dysfunctions. These dysfunctions include oxidative stress, myocardial apoptosis, mitochondrial dysfunction, inflammation, lipotoxicity, fibrosis, impaired Ca²⁺ handling, and increased fatty acid utilization. Despite significant research efforts, the molecular mechanism underlying DCM remains incompletely understood. Recent studies have highlighted the role of exosomes, which are endogenous nanovesicles, in carrying detrimental components capable of initiating and propagating disease-related signaling events. In this review, we summarize the potential underlying mechanisms of DCM and discuss the potential use of exosomes in understanding the cellular mechanisms involved and exploring therapeutic approaches for DCM. These insights and opportunities may pave the way for new advancements in the field.