Diffusion-based models have recently revolutionized image generation, achieving unprecedented levels of fidelity. However, consistent generation of high-quality images remains challenging partly due to the lack of conditioning mechanisms for perceptual quality. In this work, we propose methods to integrate image quality assessment (IQA) models into diffusion-based generators, enabling quality-aware image generation. We show that diffusion models can learn complex qualitative relationships from both IQA models' outputs and internal activations. First, we experiment with gradient-based guidance to optimize image quality directly and show this method has limited generalizability. To address this, we introduce IQA-Adapter, a novel framework that conditions generation on target quality levels by learning the implicit relationship between images and quality scores. When conditioned on high target quality, IQA-Adapter can shift the distribution of generated images towards a higher-quality subdomain, and, inversely, it can be used as a degradation model, generating progressively more distorted images when provided with a lower-quality signal. Under high-quality condition, IQA-Adapter achieves up to a 10% improvement across multiple objective metrics, as confirmed by a user preference study, while preserving generative diversity and content. Furthermore, we extend IQA-Adapter to a reference-based conditioning scenario, utilizing the rich activation space of IQA models to transfer highly specific, content-agnostic qualitative features between images.