NEW DELHI: Smoking increased the risk of death from any cause by 55% among people with diabetes, according to evidence reviewed in a new international consensus that calls for smoking cessation to be treated as an essential part of type 2 diabetes care. The experts say patients who smoke should be offered medicines, intensive behavioural counselling and regular follow-up instead of being given a one-time “quit smoking” warning.The recommendations, published in Diabetes Research and Clinical Practice, are the first dedicated international consensus on smoking cessation specifically for people with type 2 diabetes. They were developed by 35 experts from 13 countries, including Indian diabetes specialist Dr Anoop Misra.The consensus recommends varenicline as the first-line medicine where available, with nicotine replacement therapy or bupropion as alternatives when varenicline is unavailable or unsuitable. Medicines should be combined with structured, intensive behavioural support and repeated contact rather than brief counselling alone.The stronger approach reflects the added risk smoking poses in diabetes. A meta-analysis of 48 studies involving 1.13 million people found a 55% higher risk of death, while another study of about 130,000 people with diabetes found 48% higher overall mortality and 36% higher cardiovascular mortality among smokers.Doctors should review patients within two weeks of quitting and again at four weeks, checking blood sugar, weight, blood pressure and medicines, as quitting can alter drug metabolism and sometimes require dose adjustments.Weight gain, a common concern, should not deter quitting. In a US cohort of 10,809 people with type 2 diabetes, median weight gain within six years of quitting was 3.2 kg. Long-term quitters had lower all-cause mortality than continuing smokers regardless of weight gain, with mortality hazard ratios of 0.69, 0.57 and 0.51 for no gain, up to 5 kg and more than 5 kg gain, respectively.Smoking is also linked to kidney damage in diabetes, with higher risks of albuminuria and diabetic nephropathy. A Japanese study of 2,490 people with type 2 diabetes found insulin resistance rose with cigarettes smoked per day and fell with time after quitting.
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Quitting, however, can be difficult. Some patients may not recognise the link between smoking and diabetes complications, while others fear weight gain or use cigarettes to cope with stress and anxiety. The experts recommend personalised quit strategies and relapse prevention.The consensus also highlights gaps in diabetes care, where smoking cessation often remains limited to brief advice. It calls for routine smoking assessment, active treatment, metabolic monitoring and relapse prevention as part of diabetes care.
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