The rising prevalence of metabolic diseases, such as diabetes and obesity, presents a significant global health challenge. Dietary interventions, with their minimal side effects, hold great promise as effective strategies for blood sugar management. Highland barley (HB) boasts a comprehensive and unique nutritional composition, characterized by high protein, high fiber, high vitamins, low fat, low sugar, and diverse bioactive components. These attributes make it a promising candidate for alleviating high blood sugar. This review explores the mechanisms underlying the glucose-lowering properties of HB, emphasizing its nutritional profile and bioactive constituents. Additionally, it examines the impact of common HB processing techniques on its nutrient composition and highlights its applications in food products. By advancing the understanding of HB's value and mechanisms in diabetes prevention, this review aims to facilitate the development of HB-based foods suitable for diabetic patients.