Background and aims Type 1 diabetes (T1DM) affects young people during the most active years of their life. Our aim was to assess quality of life (QoL) and associated variables in a large cohort of adults with childhood-onset and adult-onset T1DM. Methods A cohort of adult patients (18 years and older) from the T1DM Registry of Turin, Italy, was recruited. Clinical characteristics and Diabetes QoL (DQOL) questionnaire were assessed by standardized procedures. Results 310 adults completed the questionnaire. Age and diabetes duration at assessment (mean ± SD) were 32.8 ± 7.3 years and 17.3 ± 6.3 years, respectively. DQOL and its subscores were in the lower quartiles of their distributions, indicating a good level of QoL. However, scores were significantly higher in females than in males, particularly for the subscale of diabetes-related worries. In multivariate analysis, lower QoL was independently associated with female sex ( β = 1.07, 95% CI 1.03–1.11, p = 0.003), higher age at onset ( β = 1.03, 1.00–1.05, p = 0.009), lower schooling ( β = 1.05, 1.00–1.09, p = 0.02), higher fasting plasma glucose ( β = 1.03, 1.01–1.05, p = 0.008), daily SMBG >4 ( β = 1.06, 1.01–1.10, p = 0.01), severe hypoglycemia over the last year ( β = 1.06, 1.01–1.11, p = 0.02), lower numbers of diabetologic visits ( β = 1.07, 1.01–1.13, p = 0.02) and hypertension ( β = 1.06, 1.02–1.10, p = 0.005). Autonomic neuropathy was associated with diabetes impact. Female sex ( β = 4.36, 2.43–7.83) and daily SMBG >4 ( β = 3.77, 1.72–8.30) were independently associated with worst level and CSII with better level ( β = 0.22, 0.07–0.68) of diabetes-related worries. Conclusions The impact of T1DM on QoL may depend on demographic, metabolic control-related variables, presence of complications and insulin delivery modality.