Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials

Abstract

ObjectivesTo evaluate the effects of more intensive smoking cessation interventions compared to less intensive interventions on smoking cessation in people with type 1 or type 2 diabetes.DesignA systematic review and meta-analysis of randomised trials of smoking cessation interventions was conducted. Electronic searches were carried out on the following databases: MEDLINE, EMBASE, CINAHL and PsycINFO to September 2013. Searches were supplemented by review of trial registries and references from identified trials. Citations and full-text articles were screened by two reviewers. A random-effect Mantel-Haenszel model was used to pool data.SettingPrimary, secondary and tertiary care.ParticipantsAdults with type 1 or type 2 diabetes.InterventionsSmoking cessation interventions or medication (more intensive interventions) compared to usual care, counselling or optional medication (less intensive interventions).Outcome measuresBiochemically verified smoking cessation was the primary outcome. Secondary outcomes were adverse events and effects on glycaemic control. We also carried out a pooled analysis of self-reported smoking cessation outcomes.ResultsWe screened 1783 citations and reviewed seven articles reporting eight trials in 872 participants. All trials were of 6 months duration. Three trials included pharmacotherapy for smoking cessation. The risk ratio of biochemically verified smoking cessation was 1.32 (95% CI 0.23 to 7.43) for the more intensive interventions compared to less intensive interventions with significant heterogeneity (I2=76%). Only one trial reported measures of glycaemic control.ConclusionsThere is an absence of evidence of efficacy for more intensive smoking cessation interventions in people with diabetes. The more intensive strategies tested in trials to date include interventions used in the general population, adding in diabetes-specific education about increased risk. Future research should focus on multicomponent smoking cessation interventions carried out over a period of at least 1 year, and also assess impact on glycaemic control.

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

“…Our findings are consistent with the meta-analysis in patients with DM in the lack of efficacy of smoking cessation intervention involving brief counseling by doctors or nurses and complemented by follow-up and self-help materials (eight trials with 872 participants reviewed, with a risk ratio of 1.32; 95%CI, 0.23–7.43)27.…”

“…The present study is the largest RCT to examine the effectiveness of an intervention on smoking cessation and glycemic control in smokers with DM and the first study to examine an intervention that consisted of brief stage-matched smoking cessation counseling in Chinese patients with type 2 DM27. Our RCT design followed the suggestions from previous studies of smoking cessation in adults with DM723.…”

“…Cancer patients in our trial were reluctant to participate for fear that their medical consultation or procedures may be missed or delayed. In addition, study of DM patients showed, insufficient evidence for the efficacy of more intensive smoking cessation interventions such as providing a more focused counseling or interview by medical advisors through face-to-face or by telephone27.…”

Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data

“…There are limited data available to inform smoking cessation in people with diabetes. Given that tobacco use disorder was the most prevalent SUD in our sample, this finding reaffirms the need for clinical research to test tailored smoking cessation interventions for people with diabetes (Nagrebetsky et al, 2014). Collaborative care models have been found to improve health outcomes for individuals with depression and diabetes, and this line of efforts should be expanded to also address SUD and related psychiatric comorbidity for people with diabetes (Huang et al, 2013).…”

Vascular Complications of Diabetes

“…There is no evidence for a treatment strategy of particular effectiveness in patients with diabetes mellitus. 170 However, in a population-based retrospective cohort study in obese smokers, patients treated with buproprion developed diabetes mellitus more often than those treated with varenicline, 171 despite similar cessation rates. In a meta-analysis of interventions, including the use of nonpharmacological interventions, referral to a smoking cessation clinic, and the use of nicotine replacement or nicotine addiction medications, the use of a variety of therapies was uniformly superior to any single therapy in smoking cessation by 6 months.…”