NEW DELHI: Globally renowned experts from 13 countries, including India, have come out with the world’s first dedicated international consensus recommendations for smoking cessation in people with type 2 diabetes.
Published in Diabetes Research and Clinical Practice, the recommendations by 35 global experts highlight that tobacco smoking among people with diabetes is associated with an increased risk of morbidity and mortality.
The guidelines thus give a clear message to clinicians: make smoking cessation an essential component of type 2 diabetes (T2D) 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 of the consensus guidelines, “Smoking in people with diabetes is not merely a lifestyle issue – it is a major cardiovascular and vascular risk factor.”
“Quitting can substantially reduce the risk of heart disease, stroke, kidney disease and limb complications. The new recommendations move beyond simply saying ‘quit’ to a structured approach combining counselling, medication and relapse prevention,” he 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,” said Dr Misra, who has been awarded the highest award for medicine in India, the Dr BC Roy award in 2006, and the Padma Shree in 2007.
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.
The international consensus recommends that clinicians make smoking cessation a routine part of diabetes management for every patient who smokes, regardless of nicotine dependence or previous quit attempts.
Among the 34 evidence-informed recommendations is offering varenicline, a prescription medication, as first-line pharmacotherapy where available; considering nicotine-replacement therapy or bupropion, another prescription medication, when it is unavailable or contraindicated.
The experts also recommended combining pharmacotherapy with structured, intensive behavioural support and repeated contact within diabetes services; reviewing patients within two weeks and again at four weeks, assessing glycaemic control, body weight, blood pressure and relevant drug-smoke interactions; embedding cessation pathways in diabetes services through electronic prompts, automated referrals and multidisciplinary coordination; and expanding research into diabetes-specific cessation strategies, emerging pharmacotherapies, e-cigarettes and digital tools.
Although leading organisations advise people with diabetes not to smoke, the experts said clinicians have lacked comprehensive, diabetes-specific guidance on treatment selection, behavioural support, relapse prevention, post-cessation metabolic monitoring and drug-smoke interactions.
Conceived and coordinated by the Centre of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania, Italy, the guidelines highlighted that smoking substantially increases cardiovascular, cerebrovascular and other complications in type 2 diabetes.
Quitting reduces these risks but can produce short-term changes in glycaemic control, body weight, blood pressure and drug metabolism.
The recommendations, therefore, position cessation as a structured, personalised clinical process - not 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.”
“People with type 2 diabetes 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,” said Professor Magdalena Walicka, lead author of the recommendations. “These recommendations close that gap by bringing treatment, metabolic monitoring and relapse prevention into one coordinated approach.”
“CoEHAR recognised this neglected need and convened an outstanding international group to address it,” said Professor Giovanni Li Volti, Director of CoEHAR.
“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.”
The initiative in this direction began in 2022, when CoEHAR researchers identified the absence of dedicated international guidance. They established the DiaSmokeFree Working Group, uniting specialists in diabetology, cardiometabolic and internal medicine, smoking cessation, behavioural science and guideline development.
The DiaSmokeFree Working Group is 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.
