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As the global prevalence of diabetes continues to rise, approximately 19% to 34% of diabetes patients will develop chronic wounds or ulcers, which significantly impacts the quality of life of these patients and also imposes a heavy economic burden on the global healthcare system. The traditional treatment methods (debridement, antibiotics, regular dressing changes, hyperbaric oxygen therapy, etc.) are facing numerous challenges, including the increasing problem of bacterial resistance, high treatment costs, and poor long-term efficacy. Therefore, developing efficient and safe new treatment strategies for diabetic wounds has become a current research hotspot. Polysaccharide-based self-healing hydrogels (PSHs) have become one of the most promising wound dressings due to their excellent self-healing ability, good biodegradability, biocompatibility, and multiple biological activities. Unfortunately, there are still limitations in the research on PSHs in the field of diabetes wound treatment. Firstly, this review comprehensively introduces the types of polysaccharides with therapeutic effects on diabetic wounds and their excellent properties. Subsequently, this article systematically reviews the self-healing mechanisms of PSHs and the therapeutic strategies for diabetic wounds. Finally, this paper reviews the challenges and future prospects of PSHs in the clinical transformation of diabetic wounds. The results provide an important reference for the application of PSHs in the field of diabetes wound treatment.