<p>Microneedle-based medical devices have gained significant attention as innovative tools for addressing challenges in wound healing, particularly in diabetic wound management. These devices offer a minimally invasive, patient-compliant platform for drug delivery, tissue regeneration, and real-time monitoring. This review provides a comprehensive overview of their design and applications, focusing on their role in modulating biological pathways and enzymatic markers essential for wound repair. Key biological pathways such as VEGF (Vascular Endothelial Growth Factor)-mediated angiogenesis, matrix metalloproteinase (MMP)-driven tissue remodeling, and inflammatory response regulation are discussed to elucidate the mechanisms underlying wound healing. The utility of biochemical markers, including oxidative stress indicators and growth factors, in evaluating wound progression is highlighted. Additionally, microneedles demonstrate unique advantages, such as enhanced bioavailability, precise drug delivery, and integration with biosensors for real-time feedback, making them ideal for chronic wound management. In the context of diabetic wounds, microneedle-based devices address specific challenges like impaired angiogenesis, prolonged inflammation, and delayed healing by facilitating localized delivery of therapeutic agents and monitoring critical biomarkers. Advanced material innovations and emerging technologies further enhance their performance and scalability. This review also examines the regulatory landscape and commercialization prospects of microneedle systems while outlining future directions, including novel materials and synergistic therapies. By bridging technological advancements with clinical needs, microneedle-based devices hold the potential to revolutionize wound care and improve outcomes in diabetic and other chronic wound conditions.</p> Graphical Abstract <p></p>