The aim of this study was to investigate the association between uric acid (UA) and cardiometabolic risk factors (CMRFs) by sex in youths with type 1 diabetes (T1D). Retrospective data collected from 1323 youths (5-18 years; 716 boys) with T1D recruited in 9 Italian Pediatric Diabetes Centers were analyzed. CMRFs included UA, HbA1c, blood pressure (BP), cholesterol (TC), HDL, triglycerides (TG), neutrophils (N) and lymphocytes (L) count, glomerular filtration rate (eGFR) (calculated using Schwartz-Lyon equation). The distribution of CMRFs was analyzed in sex-specific tertiles of UA. In the whole study population, statistically significant differences were found across UA tertiles for age, BMI, daily insulin dose, HbA1c, HDL, TG, TG/HDL ratio, TC/HDL ratio, SPISE index, N/L ratio, systolic BP, eGFR (p =0.01-0.0001). The highest tertile of UA was associated with 1,5-3,6 fold increased risk of high TG/HDL ratio, TC/HDL ratio, high BP, and MRGFR, compared to the lowest tertile in boys. Instead, in girls the highest tertile of UA was associated with two-fold increased risk of TC/HDL ratio, N/L ratio and MRGFR. Uric acid may represent a useful marker for identifying youth with T1D at high cardiometabolic risk, and association appears to vary by sex.