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Background Chronic hepatitis C virus (HCV) infection is closely associated with insulin resistance and impaired glycemic control in patients with type 2 diabetes mellitus (T2DM). While interferon-free direct-acting antiviral (DAA) therapy achieves high rates of sustained virologic response (SVR), the extent to which viral eradication improves long-term glycemic control in patients with established T2DM remains incompletely defined.Methods We conducted a systematic review and meta-analysis of cohort studies enrolling adults with chronic HCV infection and pre-existing T2DM treated with interferon-free DAA regimens. Studies reporting paired glycated hemoglobin (HbA1c) levels before and after SVR were included. Pooled mean differences in HbA1c were calculated using a random-effects model.Results Six cohort studies comprising 2,805 patients met the inclusion criteria. Overall, DAA-mediated SVR was associated with a significant reduction in HbA1c, with a pooled random-effects mean difference of −0.45% (95% confidence interval −0.74% to −0.16%). Between-study heterogeneity was substantial (I 2 = 97.8%). Subgroup analyses suggested greater HbA1c reductions among patients with poorer baseline glycemic control and in those with cirrhosis. Sensitivity analyses demonstrated that the overall findings were robust to the exclusion of individual studies.Conclusions Among patients with chronic HCV infection and established T2DM, interferon-free DAA therapy leading to SVR is associated with a modest but clinically meaningful improvement in glycemic control, despite marked heterogeneity. These findings support close monitoring of glucose levels and individualized adjustment of antidiabetic therapy following HCV eradication, particularly in patients with poor baseline control or advanced liver disease.