Death of pancreatic islet beta cells is a common feature of type 1 and 2 diabetes and often follows islet cell transplantation. Measurement of blood glucose is currently the only blunt instrument available to diagnose diabetes mellitus, and we lack tools to quantify islet cell loss or protection thereof. A class of RNA molecules (called microRNAs/miRNAs/miRs) that regulate endogenous gene expression via mRNA cleavage or translational arrest have been identified to be critical for birth, maintenance and regeneration of pancreatic beta cells. Recent demonstration that microRNAs can potentially be utilised as biomarkers due to their serum stability, has triggered increasing interest in understanding their role as regulators or biomarkers of disease. This review aims to delve into the potential of miRNA biomarkers, and whether miRNA profiles are indicators or effector of disease pathology. Furthermore, an outline for identifying and confirming islet-specific miRNA biomarkers is discussed.