Taken together, through the combination of cellular and animal models, we provided in this study that the miR-210 contained in the exosomes derived from the adipose tissue macrophages promote T2DM and obesity development by associating with and suppressing the expression of NDUFA4 gene expression in adipocytes, which provided novel insight into the molecule mechanisms underlying macrophage exosomes and microRNA-mediated diabetes pathogenesis, and might also be explored as a new target for the development of diabetes diagnosis and clinical treatment. This evidence concerns the gene COXFA4 and type 2 diabetes mellitus.