Abstract: Vanadium compounds can improve the glucose and lipid metabolism, and promote insulin signal transduction, thus exerting hypoglycemic effects and insulin protection. At the same time, they can inhibit the proliferation of tumors, induce tumor apoptosis, and limit the invasion and metastasis of tumor cells through a variety of ways. With their good pharmacokinetic properties, vanadium complexes in physiological media may interact with a variety of intracellular targets through a complex speciation change. In the past two decades, great progress has been made in the study of the biological activities and molecular mechanisms of vanadium compounds, which accelerated its rational drug design and discovery. This paper reviews the pharmacological action and potential molecular mechanism of vanadium compounds against diabetes and tumors, as well as the strategy for drug design and discovery of vanadium compounds.