Blood glucose (BG) monitoring is critical for diabetes management. In recent years, microneedle (MN)-based technology has attracted emerging attention in glucose sensing and detection. In this review, we summarized MN-based sampling for glucose collection and glucose analysis in detail. First, different principles of MN-based biofluid extraction were elaborated, including external negative pressure, capillary force, swelling force and iontophoresis, which would guide the shape design and material optimization of MNs. Second, MNs coupled with different analysis approaches, including Raman methods, colorimetry, fluorescence, and electrochemical sensing, were emphasized to exhibit the trend towards highly integrated wearable sensors. Finally, the future development prospects of MN-based devices were discussed.