The Healthcare Commission has warned primary care trusts (PCTs) that they must enhance their level of diabetes care.
A review of 111 PCTs rated 73% as "fair" in that they met patients' most basic diabetes health requirements.
Only 5% and 11% of trusts were rated as "excellent" or "good" and 12% were said to be "weak".
Trusts offering a "fair" level of care offered yearly check ups and tests but did not support patients in managing their own condition.
The commission says supporting self-care should be at the heart of most diabetes programmes.
They will be working with "weak" and "fair" PCTs to create improvement plans and will closely monitor their progress.
Healthcare Commission Chief Executive Anna Walker says: "Diabetes services that are providing 'good' and 'excellent' care to people with diabetes deserve to be praised.
"All services that provide care to people with diabetes need to look to these services and follow their example of care."