Aim: To evaluate the health related quality of life (HRQoL) of children and adolescents with type 1 diabetes (T1DM) in Kuwait using the PedsQL 4.0 Generic Core Scale (GCS) and PedsQL 3.0 Diabetes Module (DM), identify the risk factors associated with unsatisfactory QoL and their effect of metabolic control. Methods: A total of 377 children and adolescents (2-18 years) with T1DM (> 6months) and 289 without diabetes, with their parents, completed the Arabic GCS. Those with T1DM also completed the Arabic DM. Data on disease history and patient biography were collected. Results: Mean total score reported by children was 70.2 and that reported by the parents 59.3 (higher scores indicating better QoL).Young age and long duration of diabetes were associated with poor QoL (p<0.001). Males had better total scores (p < 0.001), however, females did better in treatment barriers and adherence items (p < 0.005). Higher HbA1c values were associated with lower QoL scores. Conclusion: This is the first large study in the Middle East on children and adolescents evaluating HRQoL. Efforts to achieve optimal metabolic control appear justified on QoL together with clinical grounds. QoL assessment should be an integral part of management, at least on yearly basis.