Daijiworld Media Network - New Delhi
New Delhi, Sep 5: Smoking increases 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 have recommended that people with diabetes who smoke should be offered medication, intensive behavioural counselling and regular follow-up rather than receiving only a one-time warning to quit smoking.
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. The consensus was developed by 35 experts from 13 countries, including Indian diabetes specialist Dr Anoop Misra.
The experts recommend varenicline as the first-line medication where available, with nicotine replacement therapy or bupropion as alternatives when varenicline is unavailable or unsuitable. Medication should be combined with structured and intensive behavioural support and repeated follow-up rather than brief counselling alone.
The stronger approach reflects the additional risks associated with smoking among people with diabetes. A meta-analysis of 48 studies involving 1.13 million people found that smoking was associated with a 55% higher risk of death. Another study involving around 130,000 people with diabetes found that smokers had a 48% higher risk of overall mortality and a 36% higher risk of cardiovascular mortality.
Doctors have been advised to review patients within two weeks of quitting and again after four weeks. Blood sugar, weight, blood pressure and medications should be monitored during these visits, as quitting smoking can alter drug metabolism and may sometimes require changes in medication doses.
Weight gain, which is a common concern among people attempting to quit smoking, should not discourage cessation, the experts said. In a US cohort involving 10,809 people with type 2 diabetes, the median weight gain within six years of quitting was 3.2 kg.
Long-term quitters had a lower risk of death from any cause than people who continued smoking, regardless of whether they gained weight. The mortality hazard ratios were 0.69 among those who did not gain weight, 0.57 among those who gained up to 5 kg and 0.51 among those who gained more than 5 kg.
Smoking is also associated with kidney damage among people with diabetes, including increased risks of albuminuria and diabetic nephropathy. A Japanese study involving 2,490 people with type 2 diabetes found that insulin resistance increased with the number of cigarettes smoked per day and declined with the passage of time after quitting.
However, quitting smoking can be challenging. Some patients may not recognise the connection between smoking and diabetes-related complications, while others may fear weight gain or rely on cigarettes to cope with stress and anxiety. The experts have therefore recommended personalised quitting strategies and measures to prevent relapse.
The consensus also highlights gaps in diabetes care, where smoking cessation is often limited to brief advice. It calls for routine assessment of smoking status, active treatment, metabolic monitoring and relapse prevention to become an integral part of diabetes care.