Our study revealed that insulin use is associated with higher risks of all-cause mortality [aHR 1.31 (1.18–1.45)], HCC [aHR 1.18 (1.05–1.34)], decompensated cirrhosis [aHR 1.53 (1.35–1.72)], hepatic failure [aHR 1.26 (1.42–1.86)], major cardiovascular events [aHR 1.41(1.23–1.62)], and hypoglycemia [aHR 3.33 (2.45–4.53)] than non-use of insulin (28). Here, INS is linked to Hypoglycemia.