In agreement with reports showing that insulin levels and GLP-1R agonists were not associated with increased risk of intrahepatic and perihilar CCA21–23,31, our previous study showed insulin did not enhance CCA cell proliferation in vitro39 and suggests that using GLP-1R agonists in iCCA patients with DM might be safe. The gene discussed is INS; the disease is cholangiocarcinoma.