Diabetic hepatosclerosis (DH) is a recently described form of diabetic microangiopathy with hepatic sinusoidal fibrosis and basement membrane deposition without cirrhosis. The objective was to investigate the frequency of DH and its correlation with other diabetic microangiopathic complications. Complete autopsies from 57 adults with diabetes were reviewed for liver pathology and other diabetic complications. Basement membrane deposition in the liver was highlighted using laminin and type IV collagen immunostains. Only 1 case of DH was identified. Other diabetic end-organ damage in this case included nodular glomerulosclerosis and hepatic hyaline arteriolosclerosis, which were the most severe in the series. DH is an uncommon pattern of liver disease in patients with diabetes and is associated with severe end-organ damage. This study supports the presumed vascular etiology of DH, confirms the rarity of the lesion, and supports the suggestion that it is usually accompanied by other end-organ damage.