Since 1990s, great progress has been made in the studies of vanadium drug discovery and relevant fundamental researches. However, there remain many concerns to be clarified. In this review, studies on the anti-diabetic and anti-tumor effects of vanadium complexes and the relevant molecular mechanisms were summarized, the potential use for treatment of Alzheimer's disease was indicated, and the toxicity and mechanism of the vanadium complexes were also discussed. Based on the molecular mechanism of the pharmacological/toxicological effects of vanadium complexes, three strategies for rational vanadium drug design were discussed, i.e. structural designs based on interaction with vanadium binding proteins, BMOV as lead compound, and antioxidant incorporation. The key issue for rational drug design of anti-diabetic vanadium complexes will still be how to balance the potential toxicity and pharmacological activities, and antioxidant strategies may be an effective way to the solution.