The potential improvement in uric acid (UA) levels following laparoscopic sleeve gastrectomy (LSG) in patients with obesity and type II diabetes mellitus (T2DM) has not been systematically studied. Our aim was to investigate the influencing factors of UA level improvement following LSG and its correlation with glucose metabolism and lipid metabolism.A total of 392 patients with obesity and T2DM were prospectively recruited from 1 November 2022 to 31 December 2023. All patients underwent LSG surgery and were followed at 1, 2, 3, 6, 12 months after surgery. The presurgical and postsurgical levels of body-mass index(BMI), UA and indicators of glucose metabolism and lipid metabolism were recorded.Distinct UA improvement was observed between males and females and among different BMI groups following LSG. Female patients exhibited more sustained and greater recovery of UA level up to 12 months than male patients in all BMI groups, although male patients showed a sharper UA level decrease in the first two months. Furthermore, patients with BMI ≥ 37.5 appeared to have significantly greater UA level decrease than other patients up to 12 months. UA level improvement showed significant correlation with BMI improvement in all three BMI groups in females while only in BMI 28-32.5 group in males. For glucose metabolism, a significant linear correlation between UA level changes and fasting blood glucose (FBG), fasting blood insulin (FBI), glycosylated hemoglobin A1c (HbA1c) and C-peptide (CP) was found in patients with presurgical elevated UA level group, and in female patients for FBI and CP. For lipid metabolism, a significant linear correlation was only observed between UA level changes and HDL in female and those with high presurgical UA levels.Sex and presurgical BMI appeared to influence the UA improvement following LSG. Females and those with presurgical elevated UA levels exhibited the most significant UA level alleviation. UA level changes also correlated with glucose metabolism and lipid metabolism.