After adjusting for age; sex; race; body mass index (BMI); smoking and alcohol consumption statuses; Fib‐4 score; glycated hemoglobin level; a history of hypertension, CVD, cancer history, viral hepatitis; and aspirin or statin use, we observed that insulin, sulfonylureas, and their combination with metformin were associated with a higher risk of cirrhosis and all‐cause mortality in patients with MAFLD or MASLD. Here, INS is linked to viral hepatitis.