Smoking cessation for diabetes prevention -
Talk to your health care provider about the right quit method for you to help reduce your chances of developing type 2 diabetes.
Smoking cigarettes makes managing diabetes more difficult. The high levels of nicotine from smoking cigarettes can make the cells in your body less responsive to insulin , which makes your blood sugar levels higher. People with diabetes who are exposed to a high amount of nicotine may need more insulin to regulate their blood sugar levels.
People with diabetes who smoke are also more likely to have serious health problems from diabetes, such as higher risks for serious complications, 4 , 5 including:.
According to the American Diabetes Association , diabetes was listed as the underlying cause of death for over 87, people in , making it the seventh leading cause of death in the United States.
An estimated 9, people in the U. die each year from diabetes caused by cigarette smoking. While quitting can't reverse diabetes, it can make it easier to manage your diabetes. The sooner you quit smoking , the sooner your body can start to heal.
The health benefits for people with diabetes who stop smoking begin immediately. Give you better control over your blood sugar levels 1. Insulin can become more effective at lowering blood sugar levels just eight weeks after you quit smoking.
Talk with your health care provider about whether trying FDA-approved nicotine replacement therapies NRTs to quit smoking is right for you. Your health care provider can help you create a plan to quit that is best for your health and help you better manage your diabetes.
Department of Health and Human Services USDHHS. A Report of the Surgeon General: How Tobacco Smoke Causes Disease: What It Means to You Consumer Booklet. Atlanta, GA: U. This included the use of visual images of tobacco-associated diabetic complications and video messages featuring former smokers who experienced tobacco-associated diabetic complications.
Furthermore, participants were asked about their motivational factors to quit smoking and avoid relapse Motivation , their perceived facilitators to quit smoking, their views on the use of pharmacotherapy for smoking cessation, as well as their opinions on health professional smoking cessation support Behavioral skills.
Participants were also asked about their perceived barriers and challenges to quitting smoking to help identify any characteristics that could negatively impact smoking cessation. Data were collected between April and June On indicating their interest in participating in the study, prospective participants were verbally briefed on the purpose of the study and the data-collecting procedure, answering any queries that they had.
They were also provided with a detailed information letter and a consent form to sign. Participants were reminded that participation was voluntary and that they were free to withdraw from the study at any time without the need to provide a reason.
Participants were assured that refusing to participate or withdrawing from the study did not have any effect on their care whatsoever. All participants were recruited from the diabetic clinics within the two main acute public hospitals in Malta. Participants were recruited with the aim of achieving data saturation.
However, the research team also liaised with the recruitment intermediaries to ensure adequate representation by sex, age, type of diabetes, and smoking status.
In total, 20 interviews were held. These took 30—40 minutes each and were held in Maltese or English, depending on the preference of the interviewee. All interviews were moderated by JG, who followed the interview guide.
Before starting the phone interviews, the researcher reminded participants that discussions were confidential and that the data would be rendered anonymous. Interviews were audio recorded with consent using a password-protected and encrypted audio recorder.
Once the audio recordings were transcribed and pseudonymized , these were then erased, retaining data only in an anonymous format. As some participants were already recruited to the study but not interviewed before the change in data collection method, all participants were offered this token of appreciation on completion of their interview.
All audio recordings were transcribed verbatim with anonymization and imported into NVIVO version 1. To maintain the validity and reliability of the acquired data, the transcripts in Maltese were not translated As recommended by Chen and Boore 28 , analysis was conducted in the original language Maltese or English , generating categories in the source language and then translating all identified themes and matching phrases into English.
All transcripts were analyzed by JG using applied thematic analysis, a rigorous, inductive method for identifying themes from text with the aim of presenting the meanings of the study participants as accurately and comprehensively as possible The identified themes were then organized according to the different components of the IMB model 17 and also illustrated in a figure format.
Several strategies were adopted to enhance rigor. A draft coding scheme was developed by JG based on the initial four transcripts analyzed. The coding scheme and the codes were reviewed by the other authors and revised accordingly.
Generated themes and sub-themes were supported by excerpts from the original participant data; English translations of quotes in Maltese were provided.
Additionally, the methods undertaken and data analysis processes were documented and presented so that this study can be replicated The sample included ten former and ten current smokers. Most participants were middle-aged males with type 2 diabetes.
They had at least a secondary level of education and were in employment. Nine participants reported having diabetic complication s , with five having ischemic heart problems associated with their diabetes status.
All smokers smoked daily, smoking on average 16 cigarettes per day. Six current smokers were motivated to quit smoking. However, only two were planning to quit within the next month.
All former smokers were previously daily smokers. The main findings of this study are organized according to the IMB model Figure 1 outlines the identified diabetes-specific IMB strengths and deficits, and the identified moderators.
Knowledge of smoking, smoking cessation, and diabetes. All participants, except one, were aware of the general health risks associated with smoking, mostly referring to respiratory and cardiovascular health problems.
Conversely, one former smoker and five current smokers stated that they were not aware of any additional health risks. Six participants just referred to having overall better health, while four and two participants understood that they would have better blood circulation and controlled diabetes, respectively.
On the other hand, three former smokers and six current smokers were unaware of the effects of quitting on diabetes. Perceived relevant information to support smoking cessation.
In addition, two participants perceived the need for guidance to quit smoking. Conversely, five participants stated that they would not seek any information. Views on the provision of information on tobacco-associated diabetic complications to influence smoking habits.
Ten participants also perceived that the use of visual images of tobacco-associated diabetic complications would be effective out of concern or fear.
Three participants added that it would be easier to follow and understand, and two participants stated that it would be inspiring. Various motivational factors to stop smoking or avoid a relapse were reported Table 2. On being prompted, only eight former and three current smokers stated that having diabetes was a motivator to quit smoking.
Various facilitators for smoking cessation were reported Table 3. Three participants remarked on the need to make use of nicotine replacement to quit smoking.
Attitudes towards the use of pharmacotherapy for smoking cessation. Conversely, the use of pharmacotherapy was perceived as ineffective by nine participants:. Furthermore, four participants did not perceive its need, stating that having willpower is enough:.
I quit smoking with my own willpower. In addition, two participants were uncertain about the effect of using pharmacotherapy:. Three participants were concerned about the possible health consequences of using pharmacotherapy:.
Nonetheless, six current and four former smokers stated that they would consider the use of pharmacotherapy for smoking cessation. Attitudes towards health professional smoking cessation support. On the other hand, three participants claimed that they would not seek health professional support to quit smoking, while one participant FS5 did not hold an opinion on the provision of smoking cessation support.
Several barriers and challenges that could impact directly on achieving or maintaining abstinence or indirectly by influencing the IMB model constructs or their relationships, were identified Table 4. Fourteen participants reported experiencing withdrawal symptoms on quitting smoking, particularly nervousness.
In addition, three current smokers attempted to downplay the harmful effects of smoking, undervaluing smoking cessation:. Conversely, four former smokers remarked feeling better about quitting smoking, which encouraged them to remain abstinent. Despite being aware of the general smoking health risks and the additional risks for individuals with diabetes, the participants still lacked knowledge of the association between smoking, smoking cessation, and diabetes.
Nonetheless, as was found in the study of Abu Ghazaleh et al. While the use of visual images of tobacco-associated diabetic complications has been recommended to raise awareness of such complications for encouraging cessation 23 , this study suggests otherwise, as the participants had mixed feelings about this.
Noar et al. Conversely, the participants were more receptive to the use of video messages featuring former smokers who experienced tobacco-associated diabetic complications to convey such information. The use of such video messages as part of a mass media campaign has been found to increase awareness of tobacco-related harm, quit attempts, and smoking cessation efforts amongst the general population 30 , Given these positive findings, future research should investigate the use of such video messages as an educational tool, part of a smoking cessation intervention for individuals with diabetes.
Similar to previous literature 11 - 13 , most participants identified health as their primary motivator to quit smoking and remain abstinent. As was observed in the study of Georges et al. This suggests further that some participants did not believe that smoking impacted their diabetes management.
Most of the mentioned facilitators or skills for smoking cessation such as increased health awareness, family support, and helpful distractions were also identified in previous studies 11 , As was found in the literature 11 , 13 , the participants in this study also identified the need for health professional support to quit smoking.
These suggested that this should be intensive, in line with Grech et al. Given the identified lack of smoking cessation support for those with diabetes, the provision of intensive smoking cessation support as part of diabetes management is thus recommended.
Despite the promising use of pharmacotherapy for smoking cessation among individuals with diabetes 22 , 32 , only half of the participants in this study were in favor of using it.
In addition, some participants held negative attitudes or had misconceptions about using pharmacotherapy. This warrants the need to provide more information on the benefits and use of pharmacotherapy for smoking cessation to target any negative attitudes and misconceptions. Such challenges in quitting re-confirm the need for health professional support for the identification of high-risk situations of smoking and the generation of problem-solving strategies and the use of nicotine replacement therapy for managing nicotine addiction and withdrawal symptoms.
Having diabetes was also reported as a challenge in previous literature 11 - 13 , in particular, because of possible weight gain or glycemic imbalance.
This confirms the need for tailored smoking cessation support for those who have diabetes, presenting an opportunity to introduce smoking cessation support as part of local diabetes education efforts. Guided by the IMB model, this study helped to identify the unique needs of individuals with type 1 and type 2 diabetes to quit smoking, for the future development of a tailored smoking cessation intervention.
As shown in Figure 1 , this research identified the diabetes-specific IMB strengths that can be capitalized on, and any deficits that need to be addressed, when designing a smoking cessation intervention Furthermore, as suggested by Fisher et al.
Healthcare interventions are very much dependent on patient involvement and their attitudes to them In this study, the use of purposive sampling ensured adequate representation by gender, age, education level and employment status, and different diabetes and smoking profiles.
However, none of the identified participants smoked or used to smoke on an occasional weekly basis. Occasional smokers may have different needs and preferences than those identified in this study.
Another limitation of this study was that focus group interviews could not take place as previously explained. Guided by the IMB model, this study helped to identify the unique needs of individuals with type 1 and type 2 diabetes to quit smoking, presenting practice and research recommendations.
Using video messages that showcase the true stories of former smokers with diabetes who have experienced smoking-related health issues, may have an impact on smoking cessation. Hence, future research should investigate the use of such video messages as an educational tool and as a part of a smoking cessation intervention for individuals with diabetes.
Considering the perceived lack of tailored smoking cessation support for those with diabetes and the reported diabetes-specific challenges and barriers to quitting smoking, the provision of intensive smoking cessation support as an integral part of diabetes management is also recommended.
Home Issues About. Instructions to Authors. Editorial Policies. Social Media. Exploring the smoking cessation needs of individuals with diabetes using the Information-Motivation-Behavior Skills model.
Joseph Grech 1. Ian J. Norman 2. Roberta Sammut 1. Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta.
Joseph Grech. diabetes mellitus. Introduction: Smoking cessation is an important aspect of diabetes management. Despite the increased risk for diabetes complications when smoking, evidence suggests that people living with type 1 and type 2 diabetes are less likely to quit smoking when compared to those without diabetes.
Guided by the Information- Motivation-Behavioral Skills model, this study aimed to identify the needs of individuals living with type 1 and type 2 diabetes to quit smoking.
Methods: A qualitative descriptive design was adopted. Semi-structured telephone interviews were held between April and June , with 20 former and current Maltese smokers living with type 1 or type 2 diabetes, recruited from the diabetic clinics within the two main acute public hospitals.
The interview transcriptions were analyzed using applied thematic analysis. Results: Individuals with diabetes need more information on the effects of smoking on diabetes to encourage cessation.
Preventing diabetic complications was reported as a motivator to quit smoking. However, having diabetes was identified as a challenge to quitting. Participants welcomed the provision of health professional support for quitting smoking, identifying the need to provide smoking cessation support within diabetic clinics.
Conclusions: To promote smoking cessation among individuals with diabetes, they need to be informed about how smoking affects their condition.
Utilizing video messages featuring real-life stories of former smokers with diabetes who experienced tobacco-associated diabetic complications may be influential.
Additionally, providing diabetes-specific intensive smoking cessation support is crucial to help them quit. METHODS Design A qualitative descriptive design was utilized.
Participants Both former and current smokers with type 1 or type 2 diabetes who had tried to quit following a diabetes diagnosis and were able to converse in English or Maltese were eligible for inclusion in this study.
Data collection This study was carried out during the peak of the second wave of the COVID pandemic. Procedure Data were collected between April and June RESULTS Participant characteristics The sample included ten former and ten current smokers.
a Excluding one participant who smoked five cigarillos per day. Main findings based on the IMB model The main findings of this study are organized according to the IMB model CS: current smoker. Strengths and limitations Guided by the IMB model, this study helped to identify the unique needs of individuals with type 1 and type 2 diabetes to quit smoking, for the future development of a tailored smoking cessation intervention.
The authors have each completed and submitted an ICMJE form for Disclosure of Potential Conflicts of Interest. The authors declare that they have no competing interests, financial or otherwise, related to the current work. Sammut reports that she has received funds for attending conferences from University of Malta, and had an unpaid role on the Board of Directors id-Dar tal-Providenza.
This study was funded by the Tertiary Education Scholarships Scheme, Ministry for Education, Sport, Youth, Research and Innovation, Malta. The funders had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Participants provided informed consent. The data supporting this research are available from the authors upon reasonable request. JG: collection and assembly of data, data analysis and interpretation, and writing of the manuscript.
All authors: research concept and design, critical revision and final approval of the manuscript. Boyko EJ, Magliano DJ, Karuranga S, et al. IDF Diabetes Atlas. International Diabetes Federation; Αccessed 18 September Google Scholar.
Calleja N, Azzopardi Muscat N, Reiff S, et al. Diabetes: A National Public Health Priority A National Strategy for Diabetes Accessed September 18, ElSayed NA, Aleppo G, Aroda VR, et al. Introduction and Methodology: Standards of Care in Diabetes Diabetes Care.
Seidu S, Cos X, Brunton S, et al. Prim Care Diabetes. Durlach V, Vergès B, Al-Salameh A, et al. Smoking and diabetes interplay: A comprehensive review and joint statement. Diabetes Metab. Kar D, Gillies C, Zaccardi F, et al. Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis.
Cardiovasc Diabetol. Pan A, Wang Y, Talaei M, Hu FB. Relation of Smoking With Total Mortality and Cardiovascular Events Among Patients With Diabetes Mellitus: A Meta-Analysis and Systematic Review.
Smooking Table of contents. In Gluten-free gym supplements, MM preevntion Winstanley, MH [editors]. Tobacco in Australia: Smoking cessation for diabetes prevention and issues. Melbourne: Cancer Cdssation Energy-boosting snacks Cessatio hormone insulin is produced in the pancreas and helps the body use glucose for energy. Type 1 diabetes most often occurs in childhood or young adulthood though it can occur at any age and is the result of low levels of or the inability to produce insulin. People with type 1 diabetes need insulin replacement for survival.Smoking cessation for diabetes prevention -
Make this a time when your life is fairly calm and stress levels are low. Think of your reasons for quitting, and write them down. Put the list where you'll see it every day. Throw away your cigarettes, matches, lighters and ashtrays. Ask others for their help and understanding.
Ask a friend who smokes to consider quitting with you. Step three: Choose a quitting strategy Go cold turkey. Quitting all at once works for some people. Taper off. Quit smoking gradually by cutting back over several weeks. Use a nicotine patch, gum, inhaler or spray. Or ask your doctor for a prescription medicine.
Ask your doctor about counseling, acupuncture or hypnosis. Data from the United Kingdom Prospective Diabetes Study UKPDS showed that retinopathy onset incidence in the 6-year follow-up of patients with T2DM was not associated with smoking [ 64 ]. In the study, the progression of vasculopathy was much less rapid in smokers compared with non-smokers among the patients who had diabetic retinopathy at the beginning of the study.
This discordant evidence that—compared to non-smokers—the risk of diabetic retinopathy is significantly increased in smokers with T1DM while significantly decreased in smokers with T2DM has been also confirmed recently in a meta-analysis of 73 studies [ 70 ]. The association between smoking and the risk of diabetic neuropathy has been examined in two important articles.
In the European Diabetes Prospective Complications Study, neuropathy was assessed at baseline and after a 7. The second article, a systematic review of 10 prospective cohort and 28 cross-sectional studies [ 72 ], evaluated the development of diabetic neuropathy in a total population of patients.
Over a period of 2 to 10 years, new cases of diabetic neuropathy were observed; the OR for neuropathy among smokers was not significantly higher. These discrepancies could be the result of the poor sensitivity of common methods of neuropathy testing [ 73 , 74 ].
Of interest, Ahmad and colleagues [ 75 ], by using more sensitive and specific nerve conduction studies, were able to show that smoking was an independent risk factor for manifestations of neuropathy in patients with T2DM, with heavy smokers exhibiting worse nerve conduction.
The studies on smoking and its effects on microvascular effects can seem to present a confusing relationship until other factors are considered.
The impact of smoking on these conditions varies by the type of diabetes, DM or T2DM, and by gender as well. Overall, very few rigorous prospective studies are available, and, as is too often the case, more research is necessary. The effect of smoking on glycemic control in people with diabetes is poorly studied with often contradictory results.
Cigarette smoking worsens insulin-resistance in patients with diabetes [ 76 ]; consequently, quitting smoking should improve glycemic control. Yet, smoking cessation often results in worsened glycaemic control, possibly due to the weight gain that frequently occurs after smoking abstinence [ 77 ].
A Japanese study of 25 patients with diabetes who smoke indicated poorer glycemic control in those who quit compared to patients who continued to smoke [ 78 ]. The English cohort study THIN The Health Improvement Network also showed an association between quitting smoking and worse glycemic control in T2DM patients [ 79 , 80 ].
The effects of continued smoking in the data from the Fukuoka Diabetes Registry [ 81 ] and the Swedish National Diabetes Registry [ 82 ] showed that HbA1c levels progressively increased with the number of cigarettes smoked per day.
Notwithstanding other studies have not confirmed any association between smoking and glycemic control [ 76 , 83 ]. In another cohort study of 10, men and 15, Chinese women with DM, smoking was associated with an increased risk OR of 1.
The relationship is dose-dependent and independent of traditional confounding factors, including sociodemographic and lifestyle factors. The increased risk for poor glycemic control compared to non-smokers normalized only after at least 10 years of abstinence from smoking. Another study conducted in China [ 85 ] on male patients with T2DM found that cigarette smoking was associated with increased level in fasting plasma glucose and HbA1c, particularly in treated patients with highest smoking duration and pack-years.
Compared to non-smokers, average HbA1c increase was 0. These inconsistent results could be explained by the differences in the study populations.
The discrepancies may be caused by confounding factors, in particular, known lifestyle risk factors that were not examined in some of the studies. Quitting smoking, shows clear benefits in terms of reduction or slowing of the risk for cardiovascular morbidity and mortality in people with diabetes as it does for the general population [ 86 , 87 ].
The large meta-analysis by Pan and colleagues [ 20 ] discussed earlier has shown that patients who quit smoking have a lower cardiovascular risk compared to smokers.
In T2DM patients, smoking cessation is known to decrease both short- and long-term CVD risk, even independently from weight gain [ 88 , 89 ]. More recently, a descriptive analysis of Spanish patients with T2DM smokers and former-smokers performed in a cross-sectional, multicenter, nationwide study, assessed the estimated likelihood of CHD risk at 10 years according to the UKPDS score in patients with diabetes [ 91 ].
The estimated risk of developing CHD was significantly greater in smokers compared with former-smokers. The promising finding from a nephropathy study demonstrated the quitting smoking reduced the risk of that complication to that of a never smoker.
Still for evidence on microvascular complications, the studies are limited and not conclusive. For instance, two studies have shown that smoking cessation among patients with diabetic nephropathy improved the progression of existing nephropathy [ 18 , 59 ], but its impact on newly developing diabetic nephropathy has been infrequently studied with prospective research designs.
The evidence supporting the position that quitting smoking can lower the risk of macrovascular complications among patients with diabetes is sound. We can be sure that quitting can break-up that dangerous liaison.
On the other hand, the impact of smoking cessation on the risk of microvascular complications remains without clarity, a set of confusing relationships. Further prospective studies will be needed to document and quantify the decreasing of risk of complications in patients with diabetes who stop smoking.
Abstinence from smoking will certainly produce specific benefits in patients with diabetes. This fact is reflected in the most recent guidelines on diabetes treatment [ 21 , 92 ] which include smoking cessation as a key chapter.
Current guidance highlights the importance of stopping smoking for patients with diabetes to achieve a better quality of life and to delay the onset and progression of diabetes complications.
The currently available smoking cessation therapies have been shown to double or even triple the dropout rates in controlled studies [ 93 , 94 ].
A recent study in patients with DM yielded a smoking cessation rate of However, according to a survey by Diabetes UK, Another constraint to cessation treatment is the absence of a convincing demonstration of an effective cessation interventions in patients with DM [ 97 ]. Further studies will be needed to provide clear evidence that which interventions can be valuable for these patients.
As a consequence the smoking prevalence among patients with DM continues to be similar to that found in the general population with a significantly less marked decrease trend in patients with diabetes compared to the general population [ 22 , 23 , 98 , 99 ].
These conditions mean that helping patients with diabetes to quit requires a greater commitment and the use of personalized anti-smoking strategies. Given the high risk for relapse, successful and prolonged smoking abstinence can be challenging.
Psychological support appears to be a central component of treatment. Combining personalized psychological support with standard pharmacological medications can achieve the best possible results [ , ].
Patients with diabetes who smoke should be routinely reminded that cigarette smoking increases their risk of developing disease complications, adversely affects their blood glucose control and increases their insulin-resistance. For treatment, the first line drugs used to increase the likelihood of success in smoking cessation include nicotine replacement therapy NRT , bupropion and varenicline [ , ], discussed below.
NRT is available in different formulations: chewing gum, inhalers, lozenges, sprays and transdermal patches. Their main mechanism of action is that of replacing the nicotine delivered by cigarette smoking, thus decreasing the severity of withdrawal symptoms and helping the smoker to quit [ ].
Different formulations may have a distinct impact on withdrawal symptoms or on the urge to smoke, but whether one formulation is more effective than another is open to debate. Nonetheless, NRT-based treatment doubles the chances of success in quitting smoking, regardless of the specific formulation [ , , ].
Although not formally regulated as a pharmaceutical product, electronic cigarettes are nicotinic substitutes. They are battery-powered devices that vaporize the nicotine present in the refill liquid of electronic cigarettes and, like NRT, are able to lower the severity of withdrawal symptoms [ , ].
Randomized clinical trials support the efficacy and safety of these devices [ , , ]. In particular, a recent RCT has demonstrated that electronic cigarettes are on average twice as effective as NRT for smoking cessation [ ].
Nicotinic substitutes—by virtue of the known effects on sympathetic neural stimulation and catecholamine release—can have a negative impact on the cardiovascular system and on glucose metabolism [ , ].
Some authors have raised concerns about NRTs use in DM patients with poor glyco-metabolic control given that nicotine may increase insulin-resistance [ , ].
Therefore, clinicians must consider the possibility of clinical-metabolic worsening of DM and its complications during NRT therapy. Some studies have shown an association between the use of NRT and reporting of serious cardiovascular events e.
myocardial infarction , but these events were primarily reported for patients who continued to smoke while using NRT [ ]. Two meta-analyses investigating adverse events associated with NRTs have shown increased cardiovascular symptoms including tachycardia and chest pain [ , ], but not major cardiovascular events cardiovascular death, non-fatal myocardial infarction and non-fatal stroke [ ].
A cohort study of 50, smokers who tried to quit smoking [ ] with 4-weeks use of NRT did not find any impact on cardiovascular risk. Although no specific recommendations for smokers with DM are available, it is reasonable to limit the use of NRT over time.
Buproprion was initially developed and marketed as an antidepressant, but it has become the first oral treatment without nicotine approved for smoking cessation.
It inhibits the re-uptake of norepinephrine and dopamine at the level of neuronal synapses in the central nervous system, acting as a non-competitive antagonist of nicotine receptors.
In a Cochrane review, bupropion doubles the odds of quitting smoking compared to placebo, with or without co-occurring depression [ ]. The cessation rates for bupropion treatment are practically similar to those obtained with NRT [ ].
Bupropion was determined to be safe in patients with cardiovascular disease, although occasional increases in blood pressure have been reported in smokers with hypertension [ ].
Although no studies are available in patients with DM, the use of bupropion can be considered safe for these patients. A plus for this treatment is that bupropion is able to limit the weight gain that often occurs when smoking is stopped, as demonstrated in RCTs [ , ].
Bupropion could therefore be proposed as a treatment of choice in obese patients with diabetes. Another cessation treatment is varenicline. It is a selective partial agonist of the α4ß2 nicotinic acetylcholine receptors in the ventral tegmental area of the brain which acts by attenuating the withdrawal symptoms that arise when quitting smoking [ , ].
Many RCTs have confirmed the efficacy of varenicline. A Cochrane review concluded that varenicline more than doubles the odds of quitting smoking compared to placebo [ ]. Furthermore, varenicline showed its greater efficacy compared to any form of bupropion monotherapy or with NRT [ , ].
When compared to NRT combination therapy, varenicline significantly increases the success rate in the short and medium term, but not in the long term [ , ].
The results raise questions about the relative effectiveness of intense smoking pharmacotherapies. The safety profile, varenecline appears to be safe and well tolerated by patients with DM. A retrospective analysis of data obtained from participants in 15 randomized clinical trials with varenecline showed that the distribution of the number of adverse events in patients with DM mainly nausea and headache was comparable to that of participants without diabetes [ ].
The complex interaction between smoking and DM poses multiple challenges for the researcher, the clinician and the patient. Current evidence shows that regular smoking is an important risk factor for cardiovascular morbidity and mortality in patients with diabetes.
Although the role of smoking and the impact of smoking cessation on microvascular complications has not been fully clarified, stopping smoking must remain a primary goal for people with diabetes to decrease their risk for macrovascular complications. Given that not all smokers with DM are susceptible to the detrimental effects of cigarette smoke, searching key phenotypic predictors for this vulnerability may be an important area for future investigation.
The increased recognition that regular smoking and DM is a dangerous liaison albeit with confusing relationships should stimulate greater efforts to develop effective smoking cessation programs and encourage avoidance strategies.
The high smoking prevalence among patients with diabetes, their poor level of glyco-metabolic control and their low success rates of stopping smoking all highlight the importance of systematically counseling smokers with DM of the numerous risks of smoking.
Doctors and healthcare providers therefore have a duty to alert their patients with diabetes about the additional burden of risks of caused by smoking.
The message must be strong and personalized. Physicians should evaluate the need to prescribe drugs for the treatment of nicotine addiction to decrease nicotine withdrawal symptoms that may occur: dysphoric or depressed mood, irritability, frustration or anger, anxiety and restlessness, increased cough, increased appetite, weight gain, sense of weakness and constipation.
Physicians should not hesitate to refer these patients to a specialized center and follow-up on their course of treatment. Alas, the solid bond with cigarette smoking creates a huge obstacle for the smoker, even for those who have a strong desire to quit, so much so that several attempts and treatments must be attempted before obtaining a lasting abstinence.
Where success has not be achieved, clinicians should consider alternative strategies including those based on risk reduction by using the new emerging technological devices without combustion e.
electronic cigarettes and heated tobacco devices [ , ]. Although, little is known about the health effects of long-term vaping or heated tobacco systems, we know for sure that long-term consumption of combustible cigarette is deadly liasion and can lead to the development of diabetes and other metabolic alterations.
The recent outbreak of severe acute respiratory illnesses among several hundred US young adults and teens is NOT linked to commercial nicotine vaping products; the evidence is mounting that the actual source of these illnesses is the consumption of some illegal, black market THC carts cartridges containing dangerous adulterants as recently stated by the FDA [ ].
Given that many patients with diabetes continue smoking despite the well-known health risks, these emerging technologies for nicotine delivery could be a viable and much less harmful alternative. We are aware of only one paper investigating the impact of e-cigarette use in diabetes.
A large Internet-based survey of regular e-cigarette users with diabetes [ ] found that More studies in smokers with diabetes will be required to confirm these initial findings.
Smoking and diabetes presents both a dangerous liaison and confusing relationships. While we wait for further research for more evidence, promoting smoking cessation for those with DM deserves to be a top priority.
Encouraging all smokers to quit may reduce the number of cases of DM overall. Prevalence of tobacco smoking. World Health Organization. The global tobacco epidemic. World health Organization. US Department of Health and Human Services.
The health consequences of smoking: 50 years of progress: a report of the surgeon general. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the surgeon general.
Atlanta: U. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
The health benefits of smoking cessation. Public Health Service. Centers for Disease Control. Center for Chronic Disease Prevention and Health Promotion. Office on Smohing and Health. DHHS Publication No. CDC Doll R, Peto R, Wheatley K, Gray R, Sutherland I. Article CAS PubMed PubMed Central Google Scholar.
International Agency for Research on Cancer. Tobacco control: reversal of risk after quitting smoking. International Agency for Research on Cancer NCD Risk Factor Collaboration NCD-RisC.
Worldwide trends in diabetes since. A pooled analysis of population-based studies with 4. Google Scholar. Global Report on Diabetes. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. Article Google Scholar. Pan A, Wang Y, Talaei M, Hu FB, Wu T. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis.
Lancet Diabetes Endocrinol. Article PubMed PubMed Central Google Scholar. Cacciola RR, Guarino F, Polosa R. Relevance of endothelial-hemostatic dysfunction in cigarette smoking. Curr Med Chem. Article CAS PubMed Google Scholar. Nelson KM, Boyko EJ, Koepsell T.
All-cause mortality risk among a national sample of individuals with diabetes. Diabetes Care. McEwen LN, Kim C, Karter AJ, Haan MN, Ghosh D, Lantz PM, Mangione CM, Thompson TJ, Herman WH. Risk factors for mortality among patients with diabetes: the Translating Research Into Action for Diabetes TRIAD Study.
Article PubMed Google Scholar. Wei M, Gaskill SP, Haffner SM, Stern MP. Effects of diabetes and level of glycaemia on all-cause and cardiovascular mortality.
The San Antonio Heart Study. Al-Delaimy WK, Manson JE, Solomon CG, Kawachi I, Stampfer MJ, Willett WC, Hu FB. Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus. Arch Intern Med. Chuahirun T, Simoni J, Hudson C, Seipel T, Khanna A, Harrist RB, Wesson DE. Cigarette smoking exacerbates and its cessation ameliorates renal injury in type 2 diabetes.
Am J Med Sci. Qin R, Chen T, Lou Q, Yu D. Excess risk of mortality and cardiovascular events associated with smoking among patients with diabetes: meta-analysis of observational prospective studies. Int J Cardiol. Pan A, Wang Y, Talaei M, Hu FB. Relation of smoking with total mortality and cardiovascular events among patients with diabetes mellitus: a meta-analysis and systematic review.
Standard di cura del diabete mellito AMD-SID. Ford ES, Mokdad AH, Gregg EW. Trends in cigarette smoking among US adults with diabetes: findings from the Behavioral Risk Factor Surveillance System. Prev Med. Stanton CA, Keith DR, Gaalema DE, Bunn JY, Doogan NJ, Redner R, Kurti AN, Roberts ME, Higgins ST.
Trends in tobacco use among US adults with chronic health conditions: National Survey on Drug Use and Health — Kawakami N, Takatsuka N, Shimizu H, Ishibashi H. Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus.
Replication and extensions in a Japanese cohort of male employees. Am J Epidemiol. Willi C, Bodenmann P, Ghali WA, Faris PD, Cornuz J.
Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis. Akter S, Okazaki H, Kuwahara K, et al. Smoking, smoking cessation, and the risk of type 2 diabetes among Japanese adults: Japan Epidemiology Collaboration on Occupational Health Study.
PLoS ONE. Incidence and risk factors for type 2 diabetes mellitus in transitional Thailand: results from the Thai cohort study. BMJ Open. Han SJ, Kim HJ, Kim DJ, Lee KW, Cho NH. Incidence and predictors of type 2 diabetes among Koreans: a year follow up of the Korean genome and epidemiology study.
Diabetes Res Clin Pract. Akter S, Goto A, Mizoue T. Smoking and the risk of type 2 diabetes in Japan: a systematic review and meta-analysis.
J Epidemiol. Aeschbacher S, Schoen T, Clair C, Schillinger P, Schönenberger S, Risch M, Risch L, Conen D. Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults. Swiss Med Wkly. PubMed Google Scholar.
Bucheli JR, Manshad A, Ehrhart MD, Camacho J, Burge MR. Association of passive and active smoking with pre-diabetes risk in a predominantly Hispanic population. J Investig Med. Śliwińska-Mossoń M, Milnerowicz H. The impact of smoking on the development of diabetes and its complications.
Diabetes Vasc Dis Res. Sung YT, Hsiao CT, Chang IJ, Lin YC, Yueh CY. Smoking cessation carries a short-term rising risk for newly diagnosed diabetes mellitus independently of weight gain: a 6-year retrospective cohort study.
J Diabetes Res. Yeh HC, Duncan BB, Schmidt MI, Wang NY, Brancati FL. Smoking, smoking cessation, and risk for type 2 diabetes mellitus: a cohort study. Ann Intern Med. Oba S, Noda M, Waki K, Nanri A, Kato M, Takahashi Y, Poudel-Tandukar K, Matsushita Y, Inoue M, Mizoue T, Tsugane S.
Smoking cessation increases short-term risk of type 2 diabetes irrespective of weight gain: the Japan public health center-based prospective study. Luo JH, Rossouw J, Tong E, Giovino GA, Lee CC, Chen C, Ockene JK, Qi L, Margolis KL.
Smoking and diabetes: does the increased risk ever go away? Hu Y, Zong G, Liu G, Wang M, Rosner B, Pan A, Willett WC, Manson JE, Hu FB, Sun Q. Smoking cessation, weight change, type 2 diabetes, and mortality. N Engl J Med.
American Diabetes Association. Lifestyle management: standards of medical care in diabetes Cardiovascular disease and risk management. Rawshani A, Eliasson B, Svensson AM, Miftaraj M, McGuire DK, Sattar N, Rosengren A, Gudbjörnsdottir S.
Mortality and cardiovascular disease in type 1 and type 2 diabetes. GBD Tobacco Collaborators. Smoking prevalence and attributable disease burden in countries and territories, — a systematic analysis from the Global Burden of Disease Study Roth GA, Johnson C, Abajobir A, Abd-Allah F, Abera SF, Abyu G, Ahmed M, et al.
Global, regional, and national burden of cardiovascular diseases for 10 causes, to J Am Coll Cardiol. Rawshani A. Risk factors, mortality, and cardiovascular outcomes in patients with type 2 diabetes. Wan EY, Fong DYT, Fung CSC, Yu EYT, Chin WY, Chan AKC, Lam CLK. Prediction of five-year all-cause mortality in Chinese patients with type 2 diabetes mellitus—a population-based retrospective cohort study.
J Diabetes Complicat. Barengo NC, Teuschl Y, Moltchanov V, Laatikainen T, Jousilahti P, Tuomilehto J. Coronary heart disease incidence and mortality and all-cause mortality among diabetic people according to their smoking behavior. Tob Induc Dis. Harvey JN. Trends in the prevalence of diabetic nephropathy in type 1 and type 2 diabetes.
Curr Opin Nephrol Hypertens. Boner G, Cooper ME. Diabetic nephropathy. Diabetes Technol Ther. Su S, Wang W, Sun T, Ma F, Wang Y, Li J, Xu Z. Int Urol Nephrol. Cignarelli M, Lamacchia O, Di Paolo S, Gesualdo L. Cigarette smoking and kidney dysfunction in diabetes mellitus. J Nephrol.
Christiansen JS. Cigarette smoking and prevalence of microangiopathy in juvenile-onset insulin-dependent diabetes mellitus. Gerber PA, Locher R, Schmid B, Spinas GA, Lehmann R. Smoking is associated with impaired long-term glucose metabolism in patients with type 1 diabetes mellitus.
Nutr Metab Cardiovasc Dis. Scott LJ, Warram JH, Hanna LS, Laffel LM, Ryan L, Krolewski AS. A nonlinear effect of hyperglycemia and current cigarette smoking are the major determinants of the onset of microalbuminuria in type 1 diabetes. Feodoroff M, Harjutsalo V, Forsblom C, Thorn L, Wadén J, Tolonen N, Lithovius R, Groop PH.
Smoking and progression of diabetic nephropathy in patients with type 1 diabetes. Acta Diabetol. De Cosmo S, Lamacchia O, Rauseo A, et al. Cigarette smoking is associated with low glomerular filtration rate in male patients with type 2 diabetes.
Briganti EM, Branley P, Chadban SJ, Shaw JE, McNeil JJ, Welborn TA, Atkins RC. Smoking is associated with renal impairment and proteinuria in the normal population: the AusDiab kidney study: Australian Diabetes, Obesity and Lifestyle Study.
Am J Kidney Dis. Ikeda Y, Suehiro T, Takamatsu K, et al. Effect of smoking on the prevalence of albuminuria in Japanese men with non-insulin-dependent diabetes mellitus.
Chuahirun T, Wesson DE. Cigarette smoking predicts faster progression of type 2 established diabetic nephropathy despite ACE inhibition. Chuahirun T, Khanna A, Kimball K, et al. Cigarette smoking and increased urine albumin excretion are interrelated predictors of nephropathy progression in type 2 diabetes.
Phisitkul K, Hegazy K, Chuahirun T, Hudson C, Simoni J, Rajab H, Wesson DE. Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy. Hsu CC, Hwuang SJ, Chen T, Huang MC, Shin SJ, Wen CP, Shih YT, Yang HJ, Chang CT, Chang CJ, Loh CH, Fuh MT, Li YS, Chang HY.
Cigarette smoking and proteinuria in Taiwanese men with type 2 diabetes mellitus. Diabet Med. Kar D, Gillies C, Nath M, Khunti K, Davies MJ, Seidu S.
Association of smoking and cardiometabolic parameters with albuminuria in people with type 2 diabetes mellitus: a systematic review and meta-analysis. Chaturvedi NSJ, Fuller JH. The relationship between smoking and microvascular complications in the EURODIAB IDDM complications study.
Gaedt Thorlund M, Borg Madsen M, Green A, Sjølie AK, Grauslund J. Is smoking a risk factor for proliferative diabetic retinopathy in type 1 diabetes. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR.
UKPDS risk factors for incidence and progression of retinopathy in type II diabetes over 6 years from diagnosis. Yan ZP, Ma JX. Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus.
Int J Ophthalmol. PubMed PubMed Central Google Scholar. Moss SE, Klein R, Klein BE. Association of cigarette smoking with diabetic retinopathy.
Cigarette smoking and ten-year progression of diabetic retinopathy. Yun JS, Lim TS, Cha SA, Ahn YB, Song KH, Choi JA, Kwon J, Jee D, Cho YK, Park YM, Ko SH.
Clinical course and risk factors of diabetic retinopathy in patients with type 2 diabetes mellitus in Korea. Diabetes Metab J. Guillausseau PJ, Massin P, Charles MA, Allaguy H, Guvenli Z, Virally M, Tielmans D, Assayag M, Warnet A, Lubetzki J. Glycaemic control and development of retinopathy in type 2 diabetes mellitus: a longitudinal study.
Cai X, Chen Y, Yang W, Gao X, Han X, Ji L. The association of smoking and risk of diabetic retinopathy in patients with type 1 and type 2 diabetes: a meta-analysis. Tesfaye S, Chaturvedi N, Eaton SE, et al. Vascular risk factors and diabetic neuropathy.
Clair C, Cohen MJ, Eichler F, Selby KJ, Rigotti NA. The effect of cigarette smoking on diabetic peripheral neuropathy: a systematic review and meta-analysis.
J Gen Intern Med. Dros J, Wewerinke A, Bindels PJ, van Weert HC. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med.
Ahmad A, Moinuddin A, Ahsan A, Goel A. Study of electrophysiological changes in sensory nerves among diabetic smokers. J Clin Diagn Res. Anan F, Takahashi N, Shinohara T, Nakagawa M, Masaki T, Katsuragi I, Tanaka K, Kakuma T, Yonemochi H, Eshima N, Saikawa T, Yoshimatsu H.
Smoking is associated with insulin resistance and cardiovascular autonomic dysfunction in type 2 diabetic patients. Eur J Clin Investig. Article CAS Google Scholar. Bush T, Lovejoy JC, Deprey M, Carpenter KM. The effect of tobacco cessation on weight gain, obesity and diabetes risk.
Lino K, Iwase M, Tsutsu N, Iida M. Smoking cessation and glycaemic control in type 2 diabetic patients. Diabetes Obes Metab. Taylor AE, Davies NM, Munafo MR.
Smoking and diabetes: strengthening causal inference. Lycett D, Nichols L, Ryan R, Farley A, Roalfe A, Mohammed MA, Szatkowski L, Coleman T, Morris R, Farmer A, Aveyard P.
The association between smoking cessation and glycaemic control in patients with type 2 diabetes: a THIN database cohort study. Kaizu S, Kishimoto H, Iwase M, Fujii H, Ohkuma T, Ide H, Jodai T, Kikuchi Y, Idewaki Y, Hirakawa Y, Nakamura U, Kitazono T.
Impact of leisure- time physical activity on glycemic control and cardiovascular risk factors in Japanese patients with type 2 diabetes mellitus: the Fukuoka diabetes registry. Nilsson PM, Gudbjornsdottir S, Eliasson B, Cederholm J, Steering Committee of the Swedish National Diabetes Register.
Smoking is associated with increased HbA1c values and microalbuminuria in patients with diabetes: data from the National Diabetes Register in Sweden.
Diabetes Metab. Targher G, Alberiche M, Zenere MB, Bonadonna RC, Muggeo M, Bonora E. Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus. J Clin Endocr Metab.
CAS PubMed Google Scholar. Peng K, Chen G, Liu C, et al. Association between smoking and glycemic control in diabetic patients: results from the Risk Evaluation of cancers in Chinese diabetic Individuals: a longitudinal REACTION study.
J Diabetes. Su J, Qin Y, Shen C, Gao Y, Pan EC, Pan XQ, Tao R, Zhang YQ, Wu M. Zhonghua Liu Xing Bing Xue Za Zhi. Pirie K, Peto R, Reeves GK, Green J, Beral V, Million Women Study Collaborators. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK.
Jha P, Ramasundarahettige C, Landsman V, Rostron B, Thun M, Anderson RN, McAfee T, Peto R. Association of smoking cessation and weight change with cardiovascular disease among adults with and without diabetes.
Luo JH, Rossouw J, Margolis KL. Smoking cessation, weight change, and coronary heart disease among postmenopausal women with and without diabetes. Blomster JI, Woodward M, Zoungas S, Hillis GS, Harrap S, Neal B, Poulter N, Mancia G, Chalmers J, Huxley R.
The harms of smoking and benefits of smoking cessation in women compared with men with type 2 diabetes: an observational analysis of the ADVANCE Action in Diabetes and Vascular Disease: preterax and diamicron modified release Controlled Evaluation trial.
Luque-Ramírez M, Sanz de Burgoa V, en nombre de los participantes del estudio DIABETES. Impact of smoking cessation on estimated cardiovascular risk in Spanish type 2 diabetes mellitus patients: the DIABETES study.
Rev Clin Esp. Professional Practice Committee. Standards of medical care in diabetes— Caponnetto P, Russo C, Polosa R. Smoking cessation: present status and future perspectives. Curr Opin Pharmacol.
Polosa R, Benowitz NL. Treatment of nicotine addiction: present therapeutic options and pipeline developments. Trends Pharmacol Sci.
Reid RD, Malcolm J, Wooding E, Geertsma A, Aitken D, Arbeau D, Blanchard C, Gagnier JA, Gupta A, Mullen KA, Oh P, Papadakis S, Tulloch H, LeBlanc AG, Wells GA, Pipe AL. Prospective, cluster-randomized trial to implement the ottawa model for smoking cessation in diabetes education programs in Ontario, Canada.
Diabetes UK Care Survey Results Nagrebetsky A, Brettell R, Roberts N, Farmer A. Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials.
Clair C, Meigs JB, Rigotti NA. Smoking behavior among US adults with diabetes or impaired fasting glucose. Am J Med. Fan AZ, Rock V, Zhang X, Li Y, Elam-Evans L, Balluz L. Trends in cigarette smoking rates and quit attempts among adults with and without diagnosed diabetes, United States, — Prev Chronic Dis.
Tobacco TC. A clinical practice guideline for treating tobacco use and dependence: update. Am J Prev Med.
Recovery meal timing details. A Correction to this article was pgevention on Selenium Maven integration June ddiabetes The combined harmful effects of cigarette smoking and hyperglycemia can accelerate cessatikn damage in Belly fat reduction after pregnancy with diabetes who smoke, as Energy-boosting snacks well known. Smoking cessation for diabetes prevention smoking cause diabetes? What are the effects of smoking on macro and microvascular complications? Now growing evidence indicates that regular smokers are at risk of developing incident diabetes. Since the prevalence rates of smoking in patients with diabetes are relatively similar to those of the general population, it is essential to address the main modifiable risk factor of smoking to prevent the onset of diabetes and delay the development of its complications. Check Your Risk For Diabees. Join a Program. Clinical Energy-boosting snacks. What Is Prediabetes? Program News. Cessattion now know that smoking causes type 2 diabetes. And people with diabetes who smoke are more likely than nonsmokers to have trouble with insulin dosing and with controlling their disease.
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