World's First Dedicated Smoking Cessation Guidelines for Type 2 Diabetes Released by Global Experts
核心洞察
An international panel of 35 experts from 13 countries published the first dedicated consensus recommendations for smoking cessation in people with type 2 diabetes (搜索) in Diabetes Research and Clinical Practice.
The guidelines position smoking cessation as a structured, personalized clinical intervention rather than lifestyle advice, integrating treatment, metabolic monitoring, and relapse prevention.
Varenicline is recommended as first-line pharmacotherapy, with nicotine-replacement therapy (搜索) or bupropion as alternatives, combined with intensive behavioral support and follow-up within two and four weeks.
An international panel of 35 experts from 13 countries has published the world's first dedicated consensus recommendations for smoking cessation in people with type 2 diabetes (搜索) (T2D), calling for cessation support to become a routine part of diabetes care. Published in Diabetes Research and Clinical Practice, the recommendations were conceived and coordinated by the Centre of Excellence for the Acceleration of Harm Reduction (CoEHAR (搜索)) at the University of Catania, Italy, and developed through the DiaSmokeFree Working Group.
The guidelines deliver a clear message to clinicians: make smoking cessation an essential component of type 2 diabetes (搜索) care, supported by treatment, monitoring and continued follow-up. According to Dr Anoop Misra, Chairman of Fortis CDOC Centre of Excellence for Diabetes, Metabolic Diseases and Endocrinology, New Delhi, and one of the authors, "Smoking in people with diabetes is not merely a lifestyle issue – it is a major cardiovascular and vascular risk factor."
A Structured Clinical Intervention, Not Lifestyle Advice
The recommendations move beyond simply telling patients to quit, instead outlining a structured approach combining counselling, medication and relapse prevention. "Quitting can substantially reduce the risk of heart disease, stroke, kidney disease and limb complications," Dr Misra told The New Indian Express.
"Weight gain or transient changes in glucose after quitting should be anticipated and managed, not used as reasons to continue smoking. In diabetes, smoking cessation should be treated as a clinical intervention - with the same seriousness as controlling glucose, blood pressure and cholesterol," Dr Misra added.
The guidelines state that adults with T2D who smoke require integrated, high-intensity cessation support throughout the quitting process to reduce diabetes-related complications and improve long-term health outcomes. Smoking substantially increases the risk of cardiovascular, cerebrovascular and other complications in people with type 2 diabetes (搜索), while quitting reduces these risks but can produce short-term changes in glycaemic control, body weight, blood pressure and drug metabolism.
Key Pharmacotherapy and Monitoring Recommendations
Among the 34 evidence-informed recommendations, the panel advises offering varenicline, a prescription medication, as first-line pharmacotherapy where available, and considering nicotine-replacement therapy (搜索) or bupropion when varenicline is unavailable or contraindicated. The experts recommend combining pharmacotherapy with structured, intensive behavioural support and repeated contact within diabetes services.
Patients should be reviewed within two weeks and again at four weeks, with clinicians assessing glycaemic control, body weight, blood pressure and relevant drug-smoke interactions. The recommendations also call for embedding cessation pathways in diabetes services through electronic prompts, automated referrals and multidisciplinary coordination, and for expanding research into diabetes-specific cessation strategies, emerging pharmacotherapies, e-cigarettes and digital tools.
Closing a Long-Standing Clinical Gap
Although leading organisations advise people with diabetes not to smoke, clinicians have lacked comprehensive, diabetes-specific guidance on treatment selection, behavioural support, relapse prevention, post-cessation metabolic monitoring and drug-smoke interactions. The new recommendations position cessation as a structured, personalised clinical process rather than simply lifestyle advice.
"We are immensely proud of this pioneering achievement. For the first time, clinicians have comprehensive, actionable guidance designed specifically for a high-risk population that has been overlooked for too long," said Professor Riccardo Polosa, who conceived and coordinated the initiative. "This turns a familiar instruction 'you should quit' into a practical clinical pathway for helping patients with diabetes quit safely and successfully."
Professor Magdalena Walicka, lead author of the recommendations, added: "People with type 2 diabetes (搜索) who smoke face an exceptionally high burden of preventable complications. Yet it is shocking to note that cessation support has rarely been tailored to their clinical needs. These recommendations close that gap by bringing treatment, metabolic monitoring and relapse prevention into one coordinated approach."
A Blueprint for Routine Diabetes Care
The initiative began in 2022, when CoEHAR (搜索) researchers identified the absence of dedicated international guidance. They established the DiaSmokeFree Working Group, a multidisciplinary collaboration of 35 experts from 13 countries across five continents, spanning diabetes and cardiometabolic medicine, internal medicine, smoking cessation, behavioural science and guideline methodology.
"The result is more than a consensus paper: it is a blueprint for making smoking cessation part of routine diabetes care worldwide. Our next task is to translate these recommendations into practical tools and care pathways that clinicians can use-and into measurable improvements for patients," said Professor Giovanni Li Volti, Director of CoEHAR (搜索).
Aliya Naheed, a senior scientist at icddr,b who was among the 35 experts involved, emphasised that smoking damages small blood vessels and increases the risk of complications such as high blood pressure, kidney disease and cardiovascular problems among people with diabetes. She noted that behaviour change is extremely important in managing non-communicable diseases, as treatment with medicines for diabetes, hypertension or chronic kidney disease cannot be fully effective unless patients also improve their lifestyle and practices.