First global recommendations issued on quitting smoking with type 2 diabetes

An international panel of experts has issued the world’s first dedicated recommendations on quitting smoking for people with type 2 diabetes, calling for cessation support to become a routine part of diabetes care.

Published recently in Diabetes Research and Clinical Practice, the recommendations provide clinicians with guidance on treatment, behavioural support, relapse prevention and monitoring patients after they quit.

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The initiative was coordinated by the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania. A panel of 35 experts from 13 countries developed 34 evidence-informed recommendations through an international consensus process, according to a CoEHAR press release.

Type 2 diabetes is a chronic condition in which the body does not use insulin effectively, causing blood sugar levels to rise. It is the most common form of diabetes and is often linked to lifestyle.

Smoking substantially increases the risk of cardiovascular, cerebrovascular and other complications in people with type 2 diabetes.

Quitting reduces these risks but can cause short-term changes in glycaemic control, body weight, blood pressure and drug metabolism.

Although leading organisations advise people with diabetes not to smoke, clinicians have lacked comprehensive, diabetes-specific guidance on treatment selection, behavioural support, relapse prevention, post-cessation metabolic monitoring and drug-smoking interactions.

“The recommendations therefore position cessation as a structured, personalised clinical process -- not simply lifestyle advice,” the press release said.

Aliya Naheed, a senior scientist at icddr,b, was among the 35 experts involved in developing the recommendations.

Talking to The Daily Star today, she said quitting smoking should be treated as an integral part of diabetes care rather than simply as lifestyle advice.

“Smoking cessation should be approached as a clinical treatment, with healthcare professionals helping patients quit step by step and monitoring their progress. Simply telling a patient to stop smoking is not enough; they need guidance and support throughout the process,” she said.

Smoking damages small blood vessels and increases the risk of complications such as high blood pressure, kidney disease and cardiovascular problems among people with diabetes, she said.

Behaviour change is also extremely important in managing non-communicable diseases, Naheed said, as treatment with medicines for diabetes, hypertension or chronic kidney disease cannot be fully effective unless patients also improve their lifestyle and practices.

“But this aspect often receives little attention in clinical care,” she added.

Major recommendations

The recommendations call for smoking cessation to be made a routine part of diabetes management for every patient who smokes, regardless of nicotine dependence or previous quit attempts.

They recommend varenicline as the first-line drug treatment where available, with nicotine-replacement therapy or bupropion as alternatives when it is unavailable or unsuitable. Medication should be combined with structured behavioural support and repeated follow-up through diabetes services.

Patients should be reviewed within two weeks and again at four weeks, with doctors monitoring blood sugar control, weight, blood pressure and relevant drug-smoking interactions.

The recommendations call for smoking-cessation services to be integrated into diabetes care through electronic prompts, automated referrals and multidisciplinary coordination. They also call for more research into diabetes-specific cessation strategies, newer treatments, e-cigarettes and digital tools.

The initiative began in 2022 after researchers identified a lack of international guidance specifically addressing smoking cessation among people with type 2 diabetes. The DiaSmokeFree Working Group was subsequently formed, bringing together specialists in diabetes, cardiometabolic medicine, smoking cessation, behavioural science and guideline development.