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Background: Children and adolescent with type 1 diabetes mellitus (T1DM) are considered one of the pediatric populations at highest cardiovascular risk. Aim: This cross-sectional study was aimed to assess in children and adolescents with T1DM, the clinical correlates of early morphofunctional changes of the large arteries. Methods: Children and adolescents with T1DM treated with basal-bolus insulin therapy were included in the study if they had a disease duration of at least 5 years. The following parameter were examined: waist circumference, waist/height ratio (W/H), BMI, blood pressures, lipid profile, microalbuminuria, insulin dose, HbA1c, carotid intima-media thickness (c-IMT) and the difference between the observed and 95th percentile of age and height c-IMT distribution (Δc-IMT), aortic pulse wave velocity (Ao PWV) and the difference between the observed and 90th percentile of age Ao PWV distribution (ΔPWVAo). The study population was divided into two groups, on the basis of a value of W/H < or > 0.5. Results: A total of 45 (20 males and 25 females) children and adolescents were included in the study. Their mean age was 14.0±2.7 years, their disease duration 6.2±3.5 years. Significant correlations were found between W/H and age Δc-IMT (p= 0.009), height Δc-IMT (p= 0.008), and mean c-IMT (p= 0.015). AoPWV correlated with HbA1c values (p= 0.012), diastolic blood pressures (p=0.014), triglycerides (TG) (p= 0.009) and with microalbuminuria (p= 0.017). Subjects with W/H > 0.5 have higher values of mean c-IMT (p= 0.03), age ∆cIMT (p=0.02) and height ∆cIMT (p= 0.02). Conclusion: In children and adolescents with T1DM morphofunctional changes of the large arteries are associated with different clinical features, including the waist/height ratio. It showed a stronger correlation with c-IMTA than other indices of adiposity. Its simple measurement may allow to better assess the cardiovascular risk of T1DM pediatric patients.