Aims Cardiovascular disease (CVD) represents the most frequent cause of morbidity and mortality among patients with type 1 diabetes mellitus (T1DM). Our aim was to review the evidence and conduct a meta‐analysis assessing measures of arterial stiffness by pulse wave velocity (PWV) and augmentation index (AIx) in children and adolescents with T1DM compared to healthy controls. Methods PubMed and the Cochrane Library were searched for relevant studies published up to 10 May 2021. Results Twenty‐one studies were finally included in the meta‐analysis. The T1DM group had significantly higher carotid to femoral PWV levels than that of the control group (mean difference [d]: 0.53 CI: 0.35–0.71, P < 0.00001) but with a fair heterogeneity (I 2:73%). By omitting one study with marked heterogeneity, mean difference in cfPWV remained significantly increased in the T1DM group compared to the control group (mean difference [d]: 0.37 CI: 0.27–0.48, P < 0.00001) but with improved heterogeneity (I2 = 26%). Regarding Aix, the T1DM group had a significantly higher AI@75 index than that of the control group (mean difference [d]: 0.28 CI: 0.17–0.39, P < 0.00001) and with no heterogeneity (I 2 = 8%). Conclusions Youths with T1DM show increased arterial stiffness, either as increased carotid‐femoral pulse wave velocity or increased augmentation index, early in their course of life compared to healthy controls. PROSPERO registration number CRD42021253236

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