OBJECTIVES Evaluate difficulties in handling Self Monitoring of Blood Glucose (SMBG) from a patient's perspective under normal and stressed conditions, using a new strip-free SMBG system. METHODS The newly developed HaGluMIT questionnaire captures patient-reported ease of performing 9 typical steps in the SMBG process (7-point scale: 1 (very easy) to 7 (very difficult)). Fifty insulin treated diabetes patients participating in a 2-week product evaluation study used the new Accu-Chek Mobile system in parallel to their current SMBG systems. They were asked to voluntarily fill out HaGluMIT at the beginning (current system) and the end (new system). RESULTS Thirty-six subjects completed both questionnaires and were eligible for comparative analysis (1 missing pre-evaluation and 13 missing post-evaluations). Mean SMBG duration was 14 years with currently 5.7 tests per day. Twenty-three subjects were using an insulin pump. Data logging (2.68) was perceived to be most difficult to handle under normal conditions followed by teststrip vials (2.44), lancets (2.26), carrycase (2.10), teststrips (2.06), meter (1.97), blood application (1.94), lancet device (1.91) and insulin application (1.75). Under stressed conditions scores increased an average of 0.68 points. Post-evaluations demonstrated statistically significant improvements for lancets, blood application and data logging under normal and stressed conditions in favor of the new system. The impact of stress was lower (average increase: 0.59 points). CONCLUSIONS A number of patient reported handling problems in performing SMBG are reported in former research. This might result in skipping tests or making decisions based on inaccurate measures. Data logging is perceived to be most difficult to handle, followed by lancets, teststrips/vials and carrycase. HaGluMIT captures changes in handling difficulty. Stress (e.g. from public attention, time pressure or hypoglycemic states) increases the difficulty of handling. An integrated SMBG system without single strips and lancets significantly improved handling difficulties under normal and stressed conditions.