Hepatocellular carcinoma (HCC) is the most common liver-related complication seen in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) (1). NASH is strongly associated with type 2 diabetes mellitus (T2DM) but it has also been apparent for a number of years that T2DM is associated with an increased risk of HCC independent of the presence of NASH (2). A 2006 meta-analysis of retrospective cohort studies and case-control studies demonstrated an association between T2DM and an increased risk of HCC (3). Inteational guidelines advocate surveillance for HCC in patients with NASH who have progressed to cirrhosis (4). An important clinical question is whether T2DM confers an increased risk of HCC once patients with NASH have progressed to cirrhosis. In a recent study by Yang and colleagues (5), the authors reported strong evidence that T2DM is an independent risk factor for HCC in patients with NASH-related cirrhosis. Yang and colleagues performed a retrospective analysis of a prospectively registered research dataset of patients with NASH-related cirrhosis.