OBJECTIVE-Type 1 diabetes is associated with increased microvascular complications and inflammation. The monocytemacrophage is a pivotal cell in atherogenesis. There are scanty data on noninvasive measures of microvascular abnormalities and inflammation in type 1 diabetic subjects with microvascular complications. Thus, we examined systemic and cellular biomarkers of inflammation in type 1 diabetic patients with microvascular complications (T1DM-MV patients) and type 1 diabetic patients without microvascular complications (T1DM patients) compared with matched control subjects and determined the microcirculatory abnormalities in the T1DM and T1DM-MV patients using computer-assisted intravital microscopy (CAIM).RESEARCH DESIGN AND METHODS-Fasting blood, 24-h urine, and CAIM measurements were obtained from the T1DM and T1DM-MV patients and matched control subjects. C-reactive protein, E-selectin, nitrotyrosine, monocyte superoxide, and cytokines were elevated in the T1DM and T1DM-MV patients compared with control subjects (P Ͻ 0.01).RESULTS-Severity index, as assessed by CAIM, was significantly increased in the T1DM and T1DM-MV patients compared with the control subjects (P Ͻ 0.001). There was a significant increase in C-reactive protein, nitrotyrosine, vascular cell adhesion molecule and monocyte superoxide anion release, and interleukin-1 release in T1DM-MV compared with T1DM patients (P Ͻ 0.05). T1DM-MV patients had significantly increased CAIM severity index and microalbumin-to-creatinine ratio compared with T1DM patients (P Ͻ 0.05). Furthermore, pp38MAPK, pp65, and pERK activity were significantly increased in monocytes from the T1DM and T1DM-MV patients compared with those from the controls subjects, and pp38MAPK and pp65 activity were significantly increased in the T1DM-MV compared with the T1DM patients (P Ͻ 0.01). C oronary artery disease is the main cause of death in type 1 diabetes. Type 1 diabetes is associated with an increased risk of vascular complications, and type 1 diabetic patients with proteinuria and/or retinopathy have a significantly increased risk of fatal coronary artery disease (1). Most studies have indicated that this excess risk for macrovascular complications cannot be explained solely by conventional risk factors such as dyslipidemia, hypertension, and smoking. Therefore, the diabetic state per se confers an increased propensity to accelerated atherogenesis. However, the precise mechanisms remain to be elucidated. Inflammation is pivotal in atherosclerosis (2). The monocyte-macrophage, a crucial cell in atherogenesis, is readily accessible for study. We and others have previously shown that monocytes from type 2 diabetic patients with and without complications exhibit increased proatherogenic activity compared with matched control subjects (3)(4)(5). Recently, we demonstrated that type 1 diabetic subjects exhibit increased inflammation as evidenced by increased plasma C-reactive protein (CRP) levels and increased monocyte pro-atherogenic activity (6). However, there are scanty data on...