This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic . Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate . For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions . For analyses, a hierarchical testing strategy was performed . A total of 764 participants were included in the study . Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI , 1.10 to 2.53) and for their child (OR 2.28; 95% CI , 1.54 to 3.38) when compared to the non-diabetes group . The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years . Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI , 1.70 to 3.47), particularly in those aged under 12 years old . There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years . Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.