General practice management of type 2 diabetes


Smoking cessation
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☰ Table of contents


Recommendations

Reference

Grade*

Smoking cessation should be a major focus of the management of people with smoking-related diseasess

86

RACGP, 2011

A

All smokers should be offered brief advice to quit smoking

86

RACGP, 2011

A

*Refer to Summary, explanation and source of recommendations for an explanation of the level of evidence and grade of evidence


Clinical context


Smoking is associated with an increased risk of type 2 diabetes in men and women,87 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).88

Patients with diabetes who smoke also further increase their risk of CVD, peripheral vascular disease and neuropathy (and progression of neuropathy). Smoking also increases the risk associated with hospitalisation for surgery.86


In practice


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

Guidelines for smoking cessation and a pharmacotherapy treatment algorithm are available for download from the RACGP website and in the RACGP’s Supporting smoking cessation: A guide for health professionals.86
 

ABORIGINAL AND TORRES STRAIT ISLANDER POINT

Resources and strategies for smoking cessation for Aboriginal and Torres Strait Islander peoples are available at the  Centre for Excellence in Indigenous Tobacco Control .
Specific support for Aboriginal and Torres Strait Islander peoples is also provided by Quitline.


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

There is a lack of safety data on the use of varenicline or bupropion in diabetes.

However, if diabetes is well controlled with insulin or oral glucose-lowering medication,150 mg of bupropion once daily may be prescribed. If the diabetes is poorly controlled, nicotine replacement therapy is considered preferable.86


Diabetes Australian and RACGP logo's
 
  1. The Royal Australian College of General Practitioners. Supporting smoking cessation: A guide for health professionals. East Melbourne, Vic: RACGP, 2011.
  2. 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.
  3. Targher G, Alberiche M, Zenere MB, Bonadonna RC, Muggeo M, Bonora E. Cigarette smoking and insulin resistance in patients with noninsulin-dependent diabetes mellitus. J Clin Endocrinol Metab 1997;82(11):3619–24.