Introduction <p>Vascular complications of diabetes (VCDs), categorized into microvascular and macrovascular types, lower the quality of life among individuals with diabetes mellitus (DM). microRNAs (miRNAs, miR) are being explored as biomarkers for early identification of VCDs. Numerous studies have investigated alterations in miRNAs associated with VCDs, primarily focusing on microvascular complications such as diabetic nephropathy (DN), diabetic retinopathy (DR), and diabetic foot ulcer (DFU).</p> Methods <p>We conducted a systematic review based on PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify studies on miRNAs in VCDs. We reported miRNA qPCR expression profiles and diagnostic accuracy in VCDs.</p> Results <p>A total of 281 articles were included in the systematic review, 156 articles were included in the meta-analysis on qPCR data, and eight studies were included in the diagnostic meta-analysis. miR-126-3p was the most frequently reported miRNA in VCDs. miR-192-5p distinguished DN from healthy controls with an area under the curve (AUC) of 0.96 (95% CI: 0.93–1.00) and distinguished DN from DM with an AUC of 0.79 (95% CI: 0.67–0.92). miR-221-3p distinguished DR from DM with an AUC of 0.83 (95% CI: 0.69–0.96).</p> Conclusions <p>Circulating miR-126-3p was the most promising biomarker for VCDs. More studies are needed to validate the diagnostic accuracy of miR-192 and miR-221 in VCDs.</p> Registration <p>PROSPERO registration number CRD42024603412.</p>