Abstract Background Sense of coherence (SOC) has been associated with various self-care behaviours in the general population. As the management of type 1 diabetes heavily relies on self-management, the SOC concept could also prove important in this population. This paper is a report of a study conducted among patients with type 1 diabetes to assess the associations between SOC and glycaemic control, microvascular complications, and patients' conceptions of their disease. Methods Altogether 1,264 adult patients (45% men, age range 18-82 years) with type 1 diabetes participated in this cross-sectional study. SOC was evaluated using a 13-item SOC questionnaire. Standardized assays were used to determine HbA_1c. Nephropathy status was based on albumin excretion rate and retinal laser-treatment was used as an indication of severe retinopathy. Patients' subjective conceptions of diabetes were studied using a questionnaire. Results Higher SOC scores, reflecting stronger SOC, were associated with lower HbA_1c values. Strong SOC was independently associated with reaching the HbA_1c level <7.5%. Adjusting for diabetes duration, age at onset, socioeconomic status and HbA_1c, weak SOC was associated with the presence of nephropathy among men, but not women. No associations were observed between SOC and severe retinopathy. Four dimensions describing patients' conceptions of HbA_1c, complications, diabetes control and hypoglycaemia were formed from the diabetes questionnaire. Weak SOC was independently associated with worse subjective conceptions in the dimensions of HbA_1c and hypoglycaemia. Furthermore among men, an association between weak SOC and the complications factor was observed. Conclusion Interventions to improve patients' SOC, if available, could improve patients' metabolic control and therefore also reduce the incidence of diabetic complications.