INS and hepatocellular carcinoma: One reason that patients with diabetes in this study were more likely to receive US three times or more might be because these patients are at a high risk of primary liver cancer.34–36 Notably, the association between diabetes and liver cancer is significantly strengthened when the history of diabetes is longer than 10 years.37 38 Some studies have also suggested that insulin might enhance the risk of hepatocellular cancer, whereas certain oral glucose-lowering medications and statins may decrease the risk of hepatocellular cancer.39 40