Introduction: The health of the general population cannot be well characterized from the analyses of mortality and morbidity statistics alone.It needs to consider health in terms of people’s assessment of their sense of well-being and ability to perform social roles. A diabetic self-care, consisting of daily insulin injections or oral anti diabetic agents, self-monitoring of blood glucose and diabetic recommended diet has an impact on health related quality of life. However, health related quality of life domains has been given low attention in the diabetic follow up care in Ethiopia. Objective - To assess the level of health related quality of life and associated factors among diabetic patients who are on follow up in public Hospitals of Hawassa city, Sidama Region, Ethiopia, 2021. Methods and Materials: A facility based cross-sectional study was conducted on 423 diabetic patients who were selected using systematic random sampling technique. Data were collected using modified WHO-QOL tool and were entered into Epi-Data version 3.1 and exported to statistical package for social Sciences (SPSS) version 20 for analysis. Bivariate and multivariable logistic regression analysis was done. All statistical significance tests, the cut- off value set at p < 0.05 at confidence interval of 95% was conducted. The result of the AOR was used for interpretation of strength of prediction of the independent variables to the health related quality of life. Result: A total of 418 diabetic patients were participated in the study, giving a response rate of 98.8%.The mean score(±SD) of the overall health related quality of life of the study participants was 55.8±11.16.The highest mean score was obtained in the social domain and the lowest mean score in environmental domain.Urban residence,diabetic complication, attending diabetes education and treatment satisfaction were significantly associated with overall health related quality of life. Conclusion and recommendation:The most affected domains were environmental and physical domain. Intervention is needed to prevent diabetic complication and to enhance a health related quality of patients with diabetes beyond provision of standard treatment,thereby improving the metabolic status of patients with diabetes.