This review will highlight the current challenges and barriers to diabetes management in low and lower middle income countries using the World Health Organization's 6 Building Blocks for Health Systems (service delivery; healthcare workforce; information; medical products, vaccines and technologies; financing; and leadership and governance). Low and lower middle income countries are characterized by low levels of income and insufficient health expenditure. These countries face a shift in disease burden from communicable to non-communicable diseases including diabetes. Many argue that health systems in these countries do not have the capacity to meet the needs of people with chronic conditions such as diabetes. A variety of barriers exist in terms of organization of health systems and care, human resources, sufficient information for decision-making, availability and affordability of medicines, policies, and alleviating the financial burden of care. These health system barriers need to be addressed, taking into account the need to have diabetes included in the global development agenda and also tailoring the response to local contexts including the needs of people with diabetes.