IGF1 and Insulin resistance: It has been shown that insulin resistance (IR) and activation of the insulin receptor, as well as the insulin-like growth factor 1 (IGF-1) signaling pathways, play pivotal roles in both the initiation and progression of hepatocarcinogenesis in patients with DM (Smedile and Bugianesi, 2005; Hung et al., 2010; Kanda et al., 2020).