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Diabetes mellitus (DM), a prevalent chronic metabolic disorder with a global prevalence over 10.5%, features persistent hyperglycemia-induced micro-/macro-vascular lesions and severe complications. Conventional DM management suffers from high risks of cross-infection or hypoglycemia, poor compliance, and failure to address the multi-faceted needs of integrated diagnosis and nonspecific treatment for complications. Microneedles (MNs), a minimally invasive platform that painlessly penetrates the stratum corneum to access interstitial fluid (ISF) or deliver therapeutics, has emerged as a transformative solution for DM care. Despite significant progress in developing MN-based systems for glucose monitoring, insulin delivery, and treatment of complications, challenges remain in achieving precise drug release, high loading capacity, long-term stability, and clinical translation. This review comprehensively summarizes the latest advances in MN-based platforms for DM management, covering three major glucose detection modalities with improved sensitivity and portability, gastrointestinal and glucose-responsive transdermal MNs for insulin delivery, fully integrated close-loop MN platforms, and MN applications in diabetic wound healing and other complications (ketoacidosis diagnosis, vascular disorders, neuropathy, depression). By addressing the critical gaps in scattered research, this work holds great significance for advancing minimally invasive, integrated, and patient-centered treatment models, ultimately improving the prognosis and quality of life for DM patients worldwide.