Diabetic microangiopathy possesses typical clinical manifestations such as microvascular basement membrane thickening,microangioma formation,and microcirculation disorders,and is one of the most common diabetic complications.The disease not only adversely affects the quality of life of patients,but also aggravates the economic burden of patients,and has become a major lethal factor for diabetic patients.Diabetic microangiopathy most often attacks the kidneys,retina,and nervous system.Leech,as an insect medicine with significant efficacy in activating blood circulation and removing blood stasis,its main component hirudin has the strongest thrombin inhibitor to date,which can significantly improve microcirculation,prevent platelet aggregation and play the role of lipid regulation and stabilization of plaque.The efficacy in diabetic vasculopathy is remarkable and also provides reference for its comprehensive prevention and treatment.In this paper,the application and current research status of leech and its extracts in diabetic microangiopathy are reviewed to provide more hints for further research on leech and its extracts in related diseases.