Management of type 2 diabetes: A handbook for general practice

Lifestyle interventions for management of type 2 diabetes

Smoking cessation

Management of type 2 diabetes: A handbook for general practice
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Last revised: 17 Sep 2020

Grade: Strong recommendation; high certainty

All people who smoke should be offered brief advice to quit smoking

  1. The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. 2nd edn. East Melbourne, Vic: RACGP, 2019.
These recommendations are drawn from the most recent recommendations from organisations including the National Health and Medical Research Council (NHMRC), the Scottish Intercollegiate Guidelines Network (SIGN), Diabetes Canada, the American Diabetes Association (ADA) and other relevant sources. Refer to ‘Explanation and source of recommendations’ for explanations of the levels and grades of evidence.

Smoking is associated with an increased risk of type 2 diabetes in men and women,39 and smoking negatively affects glycaemic control (eg smokers with type 2 diabetes need larger doses of insulin to achieve control similar to that of those who do not smoke).40

People with diabetes who smoke also further increase their risk of CVD, peripheral vascular disease and neuropathy (and progression of neuropathy). Smoking also increases the risks associated with surgery.8

The importance of smoking cessation in those with, or at risk of, type 2 diabetes cannot be overstated.

In the absence of contraindications, smokers who have evidence of nicotine dependence should be offered pharmacotherapy, along with behavioural support, if they are motivated to stop smoking. The choice of pharmacotherapy is based on efficacy, clinical suitability and patient choice.8

Guidelines for smoking cessation and a pharmacotherapy treatment algorithm are available in the RACGP’s Supporting smoking cessation: A guide for health professionals.

 

Aboriginal and Torres Strait Islander point

The following organisations provide resources and strategies for smoking cessation for Aboriginal and Torres Strait Islander people:

Specific support for Aboriginal and Torres Strait Islander people is also provided by Quitline.

  1. National Institute for Clinical Excellence. Guidance for the use of patient-education models for diabetes. Technology appraisal guidance TA60. London: NICE, 2003.
  2. Nordmann AJ, Suter-Zimmermann K, Bucher HC, et al. Meta-analysis comparing Mediterranean to low-fat diets for modification of cardiovascular risk factors. Am J Med 2011;124(9):841–51.e2.
  3. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2019;42:S1–194.
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  6. Diabetes Canada Clinical Practice Guidelines Expert Committee. Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2018;42:S1–325.
  7. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Diabetes Care 2016;39(6):861–77.
  8. The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. 2nd edn. East Melbourne, Vic: RACGP, 2019.
  9. Scottish Intercollegiate Guidelines Network. Management of diabetes: A national clinical guideline (updated 2017). Edinburgh: SIGN, 2017.
  10. Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: A position statement of the American Diabetes Association. Diabetes Care 2016;39(11):2065–79.
  11. Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol 2001;37:153–46.
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  13. Yang Z, Scott CA, Mao C, Tang J, Farmer AJ. Resistance exercise versus aerobic exercise for type 2 diabetes: A systematic review and meta-analysis. Sports Med 2014;44(4):487–99.
  14. Church T, Blair S, Cocreham S, et al. Effects of aerobic and resistance training on hemoglobin a1c levels in patients with type 2 diabetes: A randomized controlled trial. JAMA 2010;304(20):2253–62.
  15. Dijk J, Manders R, Tummers K, et al. Both resistance- and endurance-type exercise reduce the prevalence of hyperglycaemia in individuals with impaired glucose tolerance and in insulin-treated and non-insulin-treated type 2 diabetic patients. Diabetologia 2012;55(5):1273–82.
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  17. Royal Australian College of General Practitioners. Exercise: Type 2 diabetes. In: Handbook of non-drug interventions (HANDI). East Melbourne, Vic: RACGP, 2014.
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  21. Anderson JW, Kendall CW, Jenkins DJ. Importance of weight management in type 2 diabetes: Review with meta-analysis of clinical studies. J Am Coll Nutr 2003;22:331–39.
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  23. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002;346(6):393–403.
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  28. Thomas D, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database of Systematic Reviews 2006;(3): CD002968. doi: 10.1002/14651858.CD002968.pub2.
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  33. Australian Obesity Management Algorithm working group. Australian Obesity Management Algorithm. Australia and New Zealand: Australian Diabetes Society, Australian and New Zealand Obesity Society, Obesity Surgery Society of Australian and New Zealand, 2016.
  34. National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: NHMRC, 2013.
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  39. US Department of Health and Human Services. How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.
  40. Targher G, Alberiche M, Zenere MB, Bonadonna RC, Juggeo M, Bonara E. Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1997;82(11):3619–24.
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  42. National Health and Medical Research Council. Australian guidelines to reduce health risks from alcohol Canberra: NHMRC, 2020. [in publication].
  43. Cheyne EH, Sherwin RS, Lunt MJ, Cavan DA, Thomas PW, Kerr D. Influence of alcohol on cognitive performance during mild hypoglycaemia; implications for Type 1 diabetes. Diabet Med 2004;21(3):230–37.
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