Background and aims: There are uncertainties on the burden of hepatocellular cancer (HCC) in patients with type-2 diabetes (T2D) in France. We therefore measured national incidences and risks of inhospital HCC. Method: The data source was the 2011–2020 National Hospital Discharge database.We selected all T2D patients. HCC and competing death incidences were measured overall and without well-identified risk factors of liver disease progression, including alcoholic liver disease. Risks were computed with multinomial logistic regression models. Results: The sample comprised 2, 883, 684 adults. Mean (IQR) age was 67 (58, 77) years and 54% were men. HCC incidence (95% CI) was 1.19 (1.17–1.21) per 1000 person-years at risk, totaling 26, 136 (0.9%) cases over 12, 504, 690 patient-years. A history of alcohol use disorders and non-metabolic liver-related risk factors were recorded among 55% and 21% of incident cases, respectively. In patients without well-identified risk factors of liver disease progression, HCC incidence was 0.57 (0.55–0.58) per 1000 person-years at risk. Male sex, age in the 40–70 years category, alcohol use disorders [aOR 20.8 (20.0–21.5)], and obesity [aOR 1.24 (1.2–1.28)] were independently associated with a higher risk of HCC than of competing mortality. Conclusion: A history of alcohol use disorders was the main driver of liver disease progression to HCC in French patients with T2D. Obesity increased the risk of HCC by ∼25%. Patients with T2D should be advised to abstain from alcohol.< Leer menos