Background: Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world and is facing an epidemic of type 2 diabetes mellitus. The objective of this study was to assess the prevalence of insulin resistance (IR) and prediabetes among HCV patients. Methods: A cross-sectional case-control study was performed on 188 HCV patients admitted to the Internal Medicine Department in Menoufia University Hospital during the period from May to August 2014. Seventy persons were taken as controls. Body mass index (BMI), serum fasting glucose and fasting insulin were determined. IR was calculated by the Homeostasis Model for Assessment of Insulin Resistance (HOMA-IR), where a value of .2.0 was considered as IR and that .4.0 was considered as prediabetic state. Results: Prediabetes was significantly higher among HCV group compared with the control group. Serum fasting glucose, fasting insulin and HOMA-IR levels were significantly higher among prediabetic HCV group compared with both non-prediabetic HCV and control groups. Conclusions: HCV patients should be assessed for IR and prediabetes in their routine evaluation to avoid the double burden of diabetes mellitus and HCV.