Endothelial dysfunction may be a critical early target for preventing atherosclerosis and cardiovascular disease. Leptin/adiponectin ratio can serve as a clinical marker of endothelial dysfunction in children with type 1 diabetes. We investigated the relationship between leptin/adiponectin ratio with carotid intima-media thickness cIMT and endothelial dysfunction in 68 type 1 diabetic children mean age 8-14 years compared to 68 healthy control subjects matched for age, sex and body mass index. A serum level of leptin was measured via radioimmunoassay and adiponectin level was measured using an enzyme linked immunosorbent assay. Flow Mediated Dilatation was significantly correlated with leptin 9.906 ± 1.688 ng/dl and leptin/adiponectin L/A ratio r -0.301, p=0.079 but not with adiponectin. Statistically significant correlation was found between carotid intima media thickness and L/A ratio (r-0.274 P=0.026), leptin (r- 0.302 P=0 .012) and adiponectin (r -0.301 P=0.079). BMI was strongly statistically correlated with cIMT. CIMT, FMD, L/A ratio, and BMI may be useful surrogate markers of subclinical atherosclerosis that make early preventive interventional strategies feasible in type 1 diabetic children.