The objective of this study was to describe and compare the quality of clinical guidelines for Type 2 diabetes mellitus (T2D) from Kenya, Zimbabwe, Tanzania and Nepal. Alumni from “peoples-uni” were invited to review and evaluate T2D clinical management guidelines used in their settings. The “Appraisal of Guidelines for REsearch & Evaluation II” (AGREE II) instrument was used to evaluate the guidelines. Each guideline was randomly allocated to three assessors, who evaluated the guidelines separately and allocated scores for items on the AGREE II tool. The guidelines from Zimbabwe and Kenya scored generally better than the Tanzania and Nepal guidelines. The main areas that needed the most improvement across all the guidelines were rigour of development (41%), applicability (40%) and editorial independence (35%). There is a need to improve several aspects of T2D clinical guidelines, which is a useful starting point to improve management of these patients.