First global recommendations issued on quitting smoking with type 2 diabetes
35 experts from 13 countries call for structured support to be integrated into routine diabetes care
An international panel of experts has released the first global recommendations on quitting smoking for individuals with type 2 diabetes. These new guidelines, published in Diabetes Research and Clinical Practice, aim to integrate smoking cessation support into routine diabetes care. Coordinated by the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR) at the University of Catania, the recommendations were developed by a team of 35 experts from 13 countries through an international consensus process.
Type 2 diabetes, a chronic condition characterized by insulin resistance and elevated blood sugar levels, is closely linked to lifestyle factors, with smoking exacerbating cardiovascular, cerebrovascular, and other complications associated with the disease. While existing guidelines advise against smoking among people with diabetes, clinicians have lacked specific, evidence-based guidance on the treatment, behavioral support, relapse prevention, and post-cessation monitoring required for this high-risk population.
The new recommendations position smoking cessation as a structured, personalized clinical process, rather than merely lifestyle advice. Key recommendations include making smoking cessation a standard component of diabetes management for all smoking patients, regardless of nicotine dependence or prior quit attempts. Varenicline is suggested as the first-line pharmacological treatment, followed by nicotine-replacement therapy or bupropion when varenicline is unavailable or unsuitable.
The guidelines call for combining medication with structured behavioral support and regular follow-up appointments to monitor blood sugar control, weight, blood pressure, and potential interactions between diabetes medications and smoking cessation drugs. Smoking cessation services are recommended to be integrated into diabetes care through electronic prompts, automated referrals, and multidisciplinary collaboration.
The recommendations also emphasize the need for further research into diabetes-specific cessation strategies, emerging treatments, e-cigarettes, and digital tools. This initiative, which began in 2022, arose from a recognition of the critical gap in international guidance addressing smoking cessation among those with type 2 diabetes.
The DiaSmokeFree Working Group, comprising specialists in diabetes, cardiometabolic medicine, smoking cessation, behavioral science, and guideline development, was established to address this knowledge gap.
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