For the first time, an international consensus indicates how to accompany those with type 2 diabetes on the path to quitting smoking: medications, behavioral support and checks in the first few weeks.
Tell a person with type 2 diabetes that you have to quit smoking is easy. Actually helping her do it, and following up with her in the following weeks, is another thing. For the first time an international group of experts tries to bridge this gap, putting pen to paper how the Smoking cessation should be a full part of the treatment of diabetes. The new recommendations, published on Diabetes Research and Clinical Practicewere developed by DiaSmokeFree Working Groupwith 35 experts from 13 countries and five continents. The project was conceived and coordinated by Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) of the University of Catania. There are 34 recommendations developed on the basis of the available evidence: they indicate which treatments to use, what support to offer and above all how to follow the patient after he has stopped. The starting point is simple: smoking adds a significant risk to a disease that already exposes you to a high probability of cardiovascular and cerebrovascular complications. Yet, until now, there has been a lack of a path specifically built for those who have to deal with nicotine addiction and diabetes at the same time.
It’s no longer enough to say: “You have to stop”
The new consensus indicates the Smoking cessation as an essential and routine component of type 2 diabetes management. Not as generic advice on lifestyle, therefore, but as an intervention to be included in the care path. The indications include associating a structured and ongoing behavioral support to pharmacological treatment. When available and appropriate, the varenicline it is indicated as first-line pharmacological treatment. Nicotine replacement therapy and bupropion may be alternatives, depending on patient characteristics. It is a change of approach that brings nicotine addiction into the diabetes clinic. The patient should not be left alone with the indication to stop, but accompanied in the decision, treatment and maintenance of abstinence.
«For the first time, clinicians have comprehensive, actionable guidance specifically designed for a high-risk population that has been neglected for too long.» explains the professor Riccardo Polosacreator and coordinator of the initiative. «We thus transform the simple “you should stop smoking” into a real clinical path to help people with diabetes quit safely and effectively». The reason for this attention is also practical. In diabetic patients, smoking cessation is part of a framework in which they are already monitored blood sugar, weight, blood pressure and medications. Quitting therefore does not simply mean eliminating one cigarette after another: the change must be accompanied, especially in the initial phase.
The weeks after the last cigarette
It is precisely the period following termination that is one of the most interesting aspects of the new recommendations. Experts suggest one early reassessment, within two and four weekswith particular attention to blood sugar, weight, blood pressure and drug therapy. The reason is that changes in the may occur after termination glycemic control, body weight and metabolism of some drugs. The possible interactions between smoking and medicines must also be considered: eliminating smoking can in fact modify the metabolism of some drugs and make it necessary to re-evaluate the therapy. Follow-up also serves to intercept difficulties and prevent them relapsesbecause quitting does not necessarily coincide with the moment the last cigarette goes out. Successful treatment includes the ability to maintain abstinence over time. This is one of the elements that distinguish the new approach from a simple anti-smoking campaign. The patient with diabetes is considered a person who may need treatment, support and monitoringexactly as happens with the other aspects of his illness.
The new recommendations also open up new questions
However, consensus does not claim to have an answer to every question. Instead, it points to some areas in which the available evidence needs to be strengthened. Among these are the GLP-1 receptor agonistsdigital tools and electronic cigarettes. Experts underline that, for these approaches, there is not yet sufficient evidence to formulate definitive clinical recommendations specific for people with type 2 diabetes. The next challenge will therefore be to bring the indications into daily practice, integrating smoking cessation pathways into diabetes services and promoting coordination between the professionals involved. Ultimately, the most important news is not discovering that smoking is bad for those with diabetes. This has been known for a long time. It’s recognizing that Quitting smoking is an intervention on the health of the diabetic patient that can be treated, accompanied and monitored. The difference may seem subtle, but the doctor’s role changes: not just saying “you have to stop”, but rather offering the patient the tools to succeed and checking, in the following weeks, how the change is affecting his metabolic balance and his therapy. For those living with type 2 diabetes, what until now was a recommendation often left in the background thus enters the heart of the treatment.
