Addressing the dual challenge : managing smoking cessation in patients with diabetes

Abstract

Smoking increases complications and mortality in people with diabetes. Quitting delivers major benefits, but physiological (weight gain, insulin sensitivity shifts) and psychological barriers make cessation harder in this group. Our review article examined strategies tailored to people with diabetes. All smokers with diabetes should receive clear, personalized advice to quit, embedded in routine care. Among the available medications, varenicline has the strongest evidence in this population. Nicotine replacement therapy and bupropion may help but have limited diabetes-specific data, so they should be used with caution. Tobacco harm reduction (e-cigarettes, heated tobacco products) may facilitate switching away from combustible cigarettes and reduce exposure, although the long-term safety and efficacy in diabetes remain uncertain. Glucagon-like peptide-1 receptor agonists can aid weight and glycemic control and may indirectly support cessation. Digital tools (apps, wearables, and remote monitoring) offer real-time support and adherence tracking, although diabetes-specific effectiveness is still being established. Smoking cessation in people with diabetes requires urgent attention. Evidence-based interventions should be integrated into routine care, with particular attention given to early monitoring of glucose, body weight, and blood pressure after quitting, plus structured follow-up. More research should develop and test tailored, long-term strategies for this high-risk group, including pragmatic trials integrating harm reduction and digital support.