The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and metaanalysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% con dence interval (CI). 32 studies met the included criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR = 1.139, 95% CI: 1.089-1.192) was higher than morbidity (RR = 1.012, 95% CI: 1.004-1.019). (3) With the increase of de nition threshold, the impact of heat exposure on diabetes rised. (4) A stronger association between heat exposure and diabetes was observed in the elderly (≥ 60 years old) (RR = 1.040, 95% CI: 1.017-1.064). In conclusion, both short-term exposure to heat and cold temperatures have impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing de nitions of heatwaves at the regional level are suggested.