Islamabad: Smoking significantly increases the risk of heart disease, stroke and other major vascular complications in people with type 2 diabetes, prompting global experts to call for structured smoking-cessation treatment to become a routine part of diabetes care.
The first dedicated international recommendations on smoking cessation for people with type 2 diabetes have been published in Diabetes Research and Clinical Practice by the DiaSmokeFree Working Group, comprising 35 specialists from 13 countries, including Pakistan’s Dr Syed Abbas Raza.
The experts said doctors should assess smoking status at every initial and follow-up diabetes consultation and offer support to every patient who smokes, regardless of their level of nicotine dependence or previous unsuccessful attempts to quit.
They said smoking cessation should not be treated as occasional lifestyle advice, but integrated into diabetes clinics and treatment pathways through trained staff, counselling, referral systems, regular follow-up and access to effective medicines.
Dr Syed Abbas Raza, a contributing author and immediate past president of the International Society of Endocrinology, said smoking was among the most important modifiable risk factors for diabetes-related complications.
“Quitting is not optional. It is a critical lifestyle change that must be addressed at every initial and follow-up consultation,” he said.
The recommendations said smoking substantially increases cardiovascular, cerebrovascular and macrovascular risks in people living with type 2 diabetes, while quitting can reduce these risks and improve long-term health outcomes.
The panel recommended varenicline as the first-line medicine for smoking cessation where it is accessible and clinically appropriate. Nicotine-replacement therapy and bupropion may be considered where varenicline is unavailable or unsuitable, although evidence for these treatments specifically in people with type 2 diabetes remains less certain.
It stressed that medication should be combined with intensive, individualised behavioural support, counselling and relapse-prevention measures. Repeated contact through diabetes services was likely to be more effective than brief, one-time advice, the experts added.
The consensus recommended early follow-up, preferably within two weeks of a quit attempt and again after four weeks, to review smoking status, blood glucose, body weight and blood pressure. Doctors should also consider whether medicines need adjustment, as smoking and quitting can alter the way some drugs are processed by the body.
The experts acknowledged that weight gain and temporary fluctuations in blood glucose after quitting may concern some patients. However, they said these issues should be managed through clinical monitoring, lifestyle counselling and personalised support rather than becoming a reason to continue smoking.
“Smoking cessation deserves the same priority as the management of glucose, blood pressure and lipids,” Dr Raza said, adding that temporary concerns should not outweigh the long-term benefits of quitting.
Prof Abdul Basit, Director of the Indus Diabetes and Endocrinology Centre and Secretary General of the Diabetic Association of Pakistan, said smoking and diabetes were a dangerous combination with potentially devastating consequences.
“In Pakistan, we need to move from simply advising people to quit towards actually helping them quit,” he said. “Every successful quit attempt can mean a lower risk of serious complications and a healthier future for the patient and their family.”
The recommendations were conceived and coordinated by the Centre of Excellence for the Acceleration of Harm Reduction at the University of Catania, Italy, after researchers found in 2022 that no dedicated international guidance existed to help people with type 2 diabetes quit smoking.
The group said it would now develop practical clinical guidance, treatment information, follow-up tools and educational materials for diabetes clinics and primary healthcare settings.