Brief intervention to promote smoking cessation and improve glycemic control in smokers with type 2 diabetes: a randomized controlled trial

Abstract

The aim of the study was to examine the effects of a brief stage-matched smoking cessation intervention group compared with a control group (with usual care) in type 2 diabetes mellitus patients who smoked by randomized controlled trial. There were 557 patients, randomized either into the intervention group (n = 283) who received brief (20- minute) individualized face-to-face counseling by trained nurses and a diabetes mellitus-specific leaflet, or a control group (n = 274) who received standard care. Patient follow-ups were at 1 week, 1 month, 3 months, 6 months, and 12 months via telephone, and assessment of smoking status from 2012 to 2014. Patients smoked an average of 14 cigarettes per day for more than 37 years, and more than 70% were in the precontemplation stage of quitting. The primary outcome showed that both the intervention and control groups had similar 7-day point-prevalence smoking abstinence (9.2% vs. 13.9%; p = 0.08). The secondary outcome showed that HbA1c levels with 7.95% [63 mmol/mol] vs. 8.05% [64 mmol/mol], p = 0.49 at 12 months, respectively. There was no evidence for effectiveness in promoting the brief stage-matched smoking cessation or improving glycemic control in smokers with type 2 diabetes mellitus, particularly those in the pre-contemplation stage.

Effectiveness of a Brief Self-determination Theory–Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong

“…Participants' baseline data, including demographic characteristics, health status, and smoking history, were obtained using a structured questionnaire based on previous trials. 17,18 The questionnaires were administered face-to-face by a trained research assistant before randomization.…”

“…A structured standardized questionnaire was developed by adopting and modifying international and locally validated instruments from previous trials. 17,18 Participants' self-efficacy against tobacco was assessed by the SEQ-12, which is a valid and reliable scale that has been used in both research and clinical settings with Chinese populations in Hong Kong. 19 The health utility score was measured with the SF-6D, which reflects the level of physical, mental, and social functioning associated with a particular health state, as well as the preference weight that the general population gives to that health state.…”

“…Most existing cessation programs, including stagematched interventions and motivational interviewing, generally require implementation time exceeding 30 minutes, which is often not feasible in busy clinical settings. Previous smoking cessation RCTs 17,18,33 in outpatient clinics revealed that many patients were unwilling to undergo a long intervention by nonphysicians, and some were reluctant to participate for fear of missing or delaying their medical consultation. Moreover, because of the busy clinical environment and lack of training on smoking cessation, many health care professionals were hesitant to help smokers quit.…”

“…Previous smoking cessation trials in outpatient clinics in Hong Kong reported that approximately 70% of smokers had no intention to quit. 17,18,33 A possible reason for the low participation rate in our trial was that most eligible participants had no interest in quitting and were thus reluctant to partici-pate in a smoking cessation project. The response rate was similar to that of a previous trial on smoking cessation conducted in clinics.…”

“…Second, our retention rate of 68.5% (1076 of 1571) was similar to that of other smoking cessation trials, which usually had retention rates of approximately 70%. 17,18 Because such missing participants were analyzed as having no change in baseline smoking status, the quit rates could have been underestimated. A third limitation of this study was that only 50.3% (85 of 169) of self-reported quitters were unreachable or refused biochemical validation.…”