BACKGROUND: Various primary studies have been conducted in sub-Saharan countries on the level of health related quality of life (HRQoL) and their associated factors among diabetic patients. However, the result of these studies lacks consistency. Therefore, this systematic review and meta-analysis estimates the pooled level of HRQoL and their associated factors among diabetic patients in sub-Saharan countries. METHODS: Electronic databases predominantly PubMed were searched. Databases, such as Google and Google scholar, were searched for gray literature. A funnel plot and Egger's regression test were used to see publication bias. Heterogeneity of the studies was checked by Forest plot and I-squared statistic. Both inverse-variance fixed-effect and DerSimonian and Laird random-effects methods were applied to estimate the pooled level of HRQoL (for both WHO-QoL-BREF and SF-36) and the effect size of associated factors. RESULT: From a total 776 retrieved studies, 16 studies were included for systematic review and meta-analysis. The pooled mean score of physical health, psychological, social relation and environmental health domain of WHO-QoL-BREF were 43.12, 47.40, 46.60 and 45.59 respectively. Age had a significant association (pooled β = - 0.47), (pooled β = - 0.24), (pooled β = - 0.32) and (pooled β = - 0.03) with physical health, psychological health, social relation and environmental health domains respectively. Being rural residence (pooled β = - 0.32) was inversely associated with environmental health domain of WHO-QoL-BREF. Increased fasting blood sugar had a significant association (pooled β = - 0.08, 95% CI - 0.11, - 0.05), (pooled β = - 0.07) and (pooled β = - 0.004) with physical health, psychological health and environmental health domains respectively. Having Co-morbidity (pooled β = - 6.25) and diabetes related complication (pooled β = - 5.65) were contrarily related to physical health domain of WHO-QoL-BREF. CONCLUSION: The pooled mean of physical and environmental domains of HRQOL scores was the least compared to the psychological and social domains. Being Old age and rural residence, increased fasting blood sugar, having co-morbidity and diabetic related complications were contrarily related to level of HRQoL. Therefore, we recommend that early detection and treatment of diabetes related complication and comorbidity and control of fasting blood sugar. While doing that due attention should be given for old and rural dwellers.