Background: The risk of cardiovascular problems such as heart failure is higher in those with type 1 diabetes mellitus (T1DM). In cardiovascular-metabolic illnesses, potential diagnostic applications for the novel adipokine visfatin have been discovered. This study aimed to demonstrate the association between visfatin and cardiovascular parameters in children and adolescents who had T1DM. Methods: We performed this case-control study on 60 children distributed into 2 groups; 30 patients of T1DM subdivided into poor control group (n=16), good control group (n=14) according to hemoglobin A1C (HbA1C), and 30 well age and sex matched as a control group. They were subjected to the determination of serum visfatin level, echocardiography, and Doppler study to detect carotid intima-media thickness (CIMT). Results: Serum visfatin differed significantly between the studied groups (p=0.001). Serum visfatin was negatively correlated with serum triglycerides, HbA1C, and random blood sugar levels. Serum visfatin was positively correlated with posterior wall diameter at diastole (PWDD) and high-density lipoprotein cholesterol among cases with poor glycemic control. The optimal serum visfatin cutoff point for identifying poorly managed diabetes is 2.3975, with a corresponding area under the curve of 0.865, specificity of 81.8%, sensitivity of 87.5%, negative predictive value of 94.76%, positive predictive value of 63.6%, with overall accuracy of 83.3%. Conclusion: There is a correlation between serum visfatin levels and some of the evaluated cardiovascular parameters, demonstrating the significance of visfatin in the development of cardiovascular complications in type 1 diabetic patients, visfatin can serve as a reliable marker of CIMT