OBJECTIVES The objective of our research was to evaluate whether there is a relationship between patient compliance to blood glucose monitoring (BGM) and HRQoL. Moreover we wanted to understand what drives patients not to be compliant to BGM. METHODS Data were taken from the ROPER Diabetes program which captures information direct from diabetes patients across 27 countries on a regular basis.  For this specific study data from a sample  of 1480 diabetes patients living in the USA were collected from June to August 2013. Each patient completed a questionnaire comprising some 2000+ variables, which included the EQ-5D-5L instrument and accompanying VAS.  Patients were asked to state their recommended frequency of BGM and what their actual BGM frequency was during the past month. Moreover patients were asked to explain why they were not compliant to the recommended BGM frequency. RESULTS Not being compliant explained 52% (R² = 0,52) of the variations in HRQoL. The main reasons for not being compliant to the recommended BGM frequency were: no coverage of strips by the insurance, pain and discomfort related to blood testing, not willing to know the test result. Other less important drivers of non-compliance were: inconvenience, issues with food intake and meter malfunction. CONCLUSIONS Meter manufacturers are right when they reckon that BGM is crucial to diabetes patients’ disease management. Manufacturers have been innovating to make the blood testing as convenient as possible. Yet an important driver for not complying to the recommended BGM frequency remains to be pain and discomfort during blood testing. Manufacturers should also continue their efforts to ensure coverage of strips by the different insurance providers in the USA.