The relationship between elevated serum uric acid (SUA) and coronary heart disease (CHD) is discussed controversially. In this cross-sectional study, we evaluated the association between hyperuricaemia and small- and large-vessel diseases in diabetic patients by analyzing clinical data of 7847 diabetic patients of both sexes (Type 1 diabetes: n = 3800, Type 2 diabetes: n = 4047). Elevated serum uric acid was defined as concentrations > 7.0 mg/dl in men and > 6.6 mg/dl in women. The prevalence of hyperuricaemia was dependent on age and duration of the disease in Type 1 diabetic patients, whereas in recently diagnosed Type 2 diabetic patients the prevalence of elevated uric acid levels was higher than in patients with long-standing Type 1 diabetes, without any further increase with longer duration of the disease. An elevated uric acid level was also associated with body weight, hypertension and nephropathy in both types of diabetes and in both sexes. In women, hyperuricaemia was correlated with the presence of coronary heart disease both in Type 1 and Type 2 diabetes (p < 0.05). The exclusion of hypertension and nephropathy in the multiple logistic regression had no effect on these associations. However, after adjustment for these two factors a significant correlation between hyperuricaemia and coronary heart disease was also found in Type 2 diabetic men. In addition, increased serum uric acid was associated with gangrene in male Type 2 diabetic patients (p < 0.05). These results suggest that elevated uric acid levels are correlated with the presence of coronary heart disease in female rather than in male diabetic patients, independently of hypertension and nephropathy.