الفهرس 
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Abstract
T2DM is a common endocrine disorder encompassing multifactorial pathogenic mechanisms. These mechanisms include resistance to the action of insulin, increased hepatic glucose production, and a defect in insulin secretion, all of which contribute to the development of overt hyperglycemia. As well as skeletal muscle and adipose tissue, liver is the major target for the metabolic actions of insulin. Insulin regulates glucose homeostasis by reducing hepatic glucose output and by increasing the rate of glucose uptake by skeletal muscle and adipose tissue. Therefore IR is a common feature of advanced liver diseases from various insults.
HCV has been shown to be a lymphotropic as well as a hepatotropic virus. Replication of HCV in diseased extrahepatic organs and tissues may have cytopathic effects .
The precise biological mechanisms where by HCV infection leads to IR are not entirely clear..HCV may induce a Th1 lymphocyte immune-mediated response which leads to activation of the tumor necrosis factor (TNF)-α system and elevation of interleukin-6 levels.
Our study was conducted on 50 diabetic patients , 21 (42%) males and 29 (58%) females of the same age group (35-65 yrs) .
This group was selected according this criteria
• ADA recommendations 2019:
1. Hb A1C ≥ 6.5%.
2. FPG ≥ 126 mg/dl.
3. Random plasma glucose at any time of day without regard to time since last meal ≥ 200mg/dl plus symptoms suggestive of DM as (polyuria, polydepsia,and unexplained wt loss.).
• Chronic hepatitis C was diagnosed by positivity for anti-HCV (third-generation enzyme immunoassay).
• HCV-RNA levels >1000 IU/mL.
All patients were subjected to the following:
1. History taking and clinical examination.
2. Laboratory investigations (Complete blood count,Liver function test(Serum levels of ALT,Aspartate aminotransferase AST,Serum bilirubin, Albumin), Serum creatinine,HbA1c befor and after treatment,Fasting and post prandial blood sugar befor and after treatment,HOMA test befor and after treatment,C_peptid fasting and post prandial befor and after treatment,Lipid profil,Thyroid stimulating hormone,Antinuclear antibody,Alpha-fetoprotein.,PCR for HCV befor and after treatment,Hepatitis B surface antigen
3. Follow up for 3 months.
• Patients were not included in the study if they had (Decompensated liver disease,Renal impairment,Hepatitis B virus infection,HIV infection,Autoimmune disorders,Clinically significant cardiac or cardiovascular abnormalities,Significant reduction of their neutrophil or platelet blood counts < 50000 mm3 ).
The aim of our study is to evaluate the glycemic control modification in a case of series of hepatitis C virus -positive diabetic patient receiving direct acting antiviral medications.
Statical analysis of our study showed that there is highly significant difference between FBS, PP, and HA1c, fasting insulin, and HOMA IR before and after antiviral treatment.
There is highly statistical significant difference as regard each of cholesterol, triglycerides, HDL and LDL, with lower level observed after treatment.
There is highly statistical significant difference between before and after treatment as regard each of fasting and post-prandial C-peptide level, with lower levels detected post treatment.
In conclusion, Diabetic patients receiving direct acting antiviral medications should be closely monitored during reduction of antidiabetic drugs, especially regarding insulin and sulfonylurea, to avoid hypoglycemic events.
Based on our results we recommend for further studies on large geographical scale and on larger sample size to emphasize our conclusion.
Conclusion
A significant improvement of glycemic control was observed in diabetic patients with chronic hepatitis C who obtained sustained virologic response with a clinically meaningful de-escalation of antihyperglycemic therapy.
Recommendations
Further studies on large geographical scale and on larger sample size to emphasize our conclusion.
Rapid reduction in hepatitis C viral load during direct-acting antiviral therapy for hepatitis C may lead to improvements in glucose metabolism in patients with diabetes, potentially resulting in symptomatic hypoglycemia if diabetic treatment is continued at the same dose
Be vigilant for changes in glucose tolerance and advise patients of the risk of hypoglycemia during direct-acting antiviral therapy, particularly within the first 3 months when the viral load is being reduced, and modify diabetic medication or doses when necessary
Physicians who initiate direct-acting antiviral therapy in patients with diabetes should inform the healthcare professional in charge of the diabetic care of the patient
Report any suspected adverse drug reactions associated with direct-acting antiviral therapies to the Yellow Card Scheme without delay.