Intervention study for smoking cessation in diabetic patients: a randomized controlled trial in both clinical and primary care settings.

Abstract

Abbreviations: CHD, coronary heart disease; FTND, Fagerström Test for Nicotine Dependence; NRT, nicotine replacement therapy.A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. Intervention Study for Smoking Cessation in Diabetic PatientsA randomized controlled trial in both clinical and primary care settingsOBJECTIVE -To evaluate the effectiveness of a nurse-managed smoking cessation intervention in diabetic patients. RESEARCH DESIGN AND METHODS -This randomized controlled clinical trialinvolved 280 diabetic smokers (age range 17-84 years) who were randomized either into control (n = 133) or intervention (n = 147) groups at 12 primary care centers and 2 hospitals located in Navarre, Spain. The intervention consisted of a 40-min nurse visit that included counseling, education, and contracting information (a negotiated cessation date). The followup consisted of telephone calls, letters, and visits. The control group received the usual care for diabetic smokers. Baseline and 6-month follow-up measurements included smoking status (self-reported cessation was verified by urine cotinine concentrations), mean number of cigarettes smoked per day, and stage of change.RESULTS -At the 6-month follow-up, the smoking cessation incidence was 17.0% in the intervention group compared with 2.3% in the usual care group, which was a 14.7% difference (95% CI 8.2-21.3%). Among participants who continued smoking, a significant reduction was evident in the average cigarette consumption at the 6-month follow-up. The mean number of cigarettes per day decreased from 20.0 at baseline to 15.5 at 6 months for the experimental group versus from 19.7 to 18.1 for the control group (P Ͻ 0.01).CONCLUSIONS -A structured intervention managed by a single nurse was shown to be effective in changing the smoking behavior of diabetic patients.

Smoking Cessation in Long-Term Conditions: Is There “An Opportunity in Every Difficulty”?

“…In patients with diabetes, training primary care staff in motivational interviewing led to a threefold increase in quit rates in the intervention group (20%) compared to controls (7%) [52]. Another study showed that training diabetes nurses in smoking cessation could significantly increase quit rates (17% versus 2.3%) [53]. In COPD patients, a Cochrane review (five RCTs; two, high quality) concluded, behavioural and pharmacological interventions combined are superior to usual care or behavioural intervention alone in achieving sustained abstinence [54].…”

Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes

“…The effectiveness of smoking cessation interventions in primary care has been demonstrated through randomized controlled trials in both the general population and among people with diabetes. [12][13][14]27 However, few studies have examined whether such interventions have a differential impact across socioeconomic and ethnic groups and whether such an effect contributes to health inequalities. 12 We found no evidence to suggest that pay-for-performance incentives increased variation in support for smokers and smoking rates 29 A recent British study found that the prevalence of smoking among white Europeans with diabetes (men, 22.2%; women, 20.0%) was similar to the prevalence in the general population.…”

Smoking cessation in patients with diabetes mellitus: Results from a controlled study of an intervention programme in primary healthcare in Sweden

“…In total, 11% of the smokers agreed to participate and were randomized into intervention or control groups; 5% were non-smokers after six months in a structured behaviour therapy anti-smoking programme and 16% in the control group receiving anti-smoking advice given once by a physician. In a Spanish study, diabetes patients from both primary care and two hospitals were initially invited to participate in a general lifestyle study [19]. After a structured interview with a nurse, 280 patients were randomized to an experimental or control group.…”