Effect of Direct-Acting Antiviral Therapy on Glycemic Control in Patients with Chronic Hepatitis C and Type 2 Diabetes: A Systematic Review and Meta-Analysis

The eradication of hepatitis C virus (HCV) with interferon-free direct-acting antivirals (DAAs) has transformed the management of chronic HCV infection. Chronic HCV infection is associated with an increased risk of type 2 diabetes mellitus (T2DM) and poor glycemic control. However, the magnitude and consistency of improvement in glycated hemoglobin (HbA1c) after DAA-induced sustained virologic response (SVR) in patients with established T2DM remain unclear. We conducted a systematic review and meta-analysis of six cohort studies comprising 2805 patients. Overall, DAA therapy was associated with a significant reduction in HbA1c after SVR, with a pooled random-effect mean difference of -0.45% (95% CI -0.74% to -0.16%; I² = 97.8%). This effect is highly heterogeneous but suggests that HCV may be a modifiable contributor to chronic hyperglycemia. These findings highlight the need for close glucose monitoring and individualized adjustment of antidiabetic therapy after SVR to optimize metabolic outcomes.