This finding, along with dose-response relationships between the duration of diabetes, fasting blood glucose measurements, and incident HCC, support a potentially causal relationship.3,8,11,14,18,30 While the pathophysiological mechanisms underlying cancer risk in diabetes are thought to be driven by insulin and growth factor exposure, hemoglobin A1c (HgbA1c) measurements have been used as a proxy for insulin resistance and endogenous insulin exposure in clinical research. This evidence concerns the gene INS and hepatocellular carcinoma.