Smoking in men and women with type 2 diabetes: A qualitative gender-sensitive exploration of barriers to smoking cessation among people with type 2 diabetes

Abstract

Objectives Despite growing evidence of the impact of smoking on diabetes complications, people with type 2 diabetes still smoke at high rates and little is known about the specific barriers to quit smoking in this group. The purpose of this article is to explore the perception of smoking, and motivation and barriers to quit among smokers with type 2 diabetes. This exploratory study will help designing a smoking cessation intervention tailored to the needs of people with type 2 diabetes. We hypothesize both that living with diabetes and gender may raise additional difficulties to quit smoking. Setting The qualitative exploratory research included ten in-depth semi-structured individual interviews and five focus groups conducted in an Ambulatory Care University Hospital in Switzerland. The thematic analysis was conducted with a gender-sensitive focus. Participants Both current and former smokers recruited from the ambulatory clinic and the community took part in the qualitative interviews. We restricted the analysis to 21 current smokers only. Results The sample included 12 men and 9 women with type 2 diabetes, having a mean age of 59.4 years, who had diabetes for an average of 9 years with a mean HbA1c of 7.4%. We found that harmful effects of tobacco were superficially understood, and participants used several patterns of thinking to minimize the risks. The relation between tobacco and diabetes was poorly known. Readiness to change was related to personal self-image and meaningful engagement in life and social relationships. Barriers could be organized into three groups: dependence, psychological habits and social barriers. Barriers were markedly shaped by gender and living with diabetes. Conclusions Results suggest that “one -fits-all” smoking cessation interventions do not satisfy the needs of type 2 diabetic smokers. Personalized smoking cessation interventions should be preferred and should pursue positive psychological outcomes addressing contextual factors.

Assessing the efficacy and impact of a personalised smoking cessation intervention among type 2 diabetic smokers: study protocol for an open-label randomised controlled trial (DISCGO-RCT)

“…73 74 For the present study, we will use an evidence-based smoking cessation intervention and tailor it to the participants from the findings of the previous phases of our study. 75 …”

“…This study, DISCGO-RCT (Diabetes and Smoking Cessation: a Gender-Oriented Randomised Controlled Trial) is the next phase of the DISCGO-MIX study (CER-VD project ID: 302/15, Swissethics ID PB_2016–01459) (purple area of figure 1 ; see also below for details), which is intended to define the beliefs, motivations and specific needs of diabetic smokers by using a mixed-methods approach. 75 Using qualitative methods, we explored patients with diabetes and healthcare provider’s experiences and priorities. We adapted the intervention on the basis of their comments and preferences (eg, no interest in group sessions, desire for a motivational and ‘guilt-free’ approach).…”

“…73 74 For the present study, we will use an evidence-based smoking cessation intervention and tailor it to the participants from the findings of the previous phases of our study. 75 The smoking cessation intervention will be standardised and follow Swiss and international guidelines. 73 76 77 It will include both psychosocial support and evidenced-based pharmacotherapy treatment, which produce higher success rates when combined.…”

Avoid clinical inertia: Importance of asking and advising patients with diabetes who smoke about quitting

“…Smoking is also related to poor glycemic control in diabetes patients 2 . A qualitative study of type 2 diabetes patients who smoked showed that willingness to change smoking behaviors was related to personal self‐image, and meaningful engagement in life and social relationships 3 , implying a possible lack of these factors in type 2 diabetes patients who continue to smoke. As tobacco smoking is the most popular form of substance use disorders, or an addiction, the patients should be referred to evidence‐based smoking cessation therapies before it is too late.…”

TRACK (by NEHEP) Implementation: A Bangladesh Scenario

“…Up to 65% of cardiovascular mortality is attributable to interaction between smoking and diabetes. Research suggests that diabetic people who smoke have poorer diabetes control, greater insulin needs, increased insulin resistance and increased risk of hypoglycemia [132].…”