OBJECTIVE Hepatitis C virus (HCV) infection is associated with diabetes and may worsen glycemic control in patients with diabetes. We aimed to investigate whether eradication of HCV infection with direct-acting antiviral (DAA) agents is associated with improved glycemic control in patients with diabetes.

RESEARCH DESIGN AND METHODS We identified 2,435 patients with diabetes who underwent interferon-free and ribavirin-free DAA-based antiviral treatment for HCV in the national Veterans Affairs health care system. Changes in average hemoglobin A_1c (HbA_1c) level and use of antidiabetic medications 1 year before and after antiviral treatment were compared between patients who achieved sustained virologic response (SVR) and those who did not.

RESULTS Among patients with elevated baseline HbA_1c, the drop in HbA_1c associated with antiviral treatment was greater in those who achieved SVR (0.98%) than in those who sustained treatment failure (0.65%) (adjusted mean difference 0.34, P = 0.02). Use of antidiabetic medications decreased more in patients who achieved SVR than in those who sustained treatment failure, especially for the use of insulin, which dropped significantly from 41.3% to 38% in patients achieving SVR compared with a slight increase from 49.8% to 51% in those who sustained treatment failure.

CONCLUSIONS DAA-based eradication of HCV is associated with improved glycemic control in patients with diabetes as evidenced by decreased mean HbA_1c and decreased insulin use. These endocrine benefits of SVR provide additional justification for considering antiviral treatment in all patients with diabetes.

目的丙型肝炎病毒（HCV）感染与糖尿病有关，可能会使糖尿病患者的血糖控制恶化。我们旨在调查用直接作用抗病毒药物（DAA）根除HCV感染是否与改善糖尿病患者的血糖控制有关。

研究设计和方法我们在国家退伍军人事务卫生保健系统中确定了2,435例糖尿病患者，他们接受了无干扰素和无利巴韦林的基于DAA的HCV抗病毒治疗。比较了获得持续病毒学应答（SVR）的患者和未获得病毒学应答的患者在抗病毒治疗前后1年的平均血红蛋白A _1c（HbA _1c）水平变化和使用降糖药的情况。

结果在升高的患者基线的HbA _1c中，在糖化血红蛋白下降_1C与抗病毒治疗相关的是更大的那些谁比那些谁持续治疗失败（0.65％）获得SVR（0.98％）（调整平均差0.34，P = 0.02） 。达到SVR的患者使用降糖药比持续治疗失败的患者减少更多，尤其是对于使用胰岛素的患者，达到SVR的患者从41.3％降至38％显着下降，而从49.8％降至51％略有上升在那些持续治疗失败的人中。

结论基于DAA的HCV根除与改善的糖尿病患者血糖控制有关，这可通过降低平均HbA _1c和减少胰岛素使用来证明。SVR的这些内分泌优势为在所有糖尿病患者中考虑抗病毒治疗提供了进一步的依据。