The impact of smoking and quitting smoking on patients with diabetes

Abstract

Although cigarette smoking is the leading avoidable cause of death in the United States, its specific effects on people with diabetes are even more intricate and profound. Macrovascular and microvascular complications ensue more quickly in smokers with diabetes, and risk of mortality increases. The increased blood pressure and altered lipid profiles in smokers with diabetes could encourage development of the insulin resistance syndrome, setting patients up for further cardiovascular problems. Therefore, smoking cessation programs should be offered to the diabetic population. Such group programs can benefit from using behavioral change methods to devise specific strategies for smoking cessation and to prevent unique problems, such as postcessation weight gain and depression. A variety of medications are available to clinicians advising smoking cessation for patients with diabetes. Studies have not proven any one smoking cessation medication to be more effective than another, so the choice for pharmacotherapy depends on the unique needs of the individual. Bupropion may be a reasonable choice because of its use for depression and its ability to delay weight gain. However, many patients prefer the ease of use of certain nicotine replacement strategies. Clinicians may find combination strategies to be particularly useful. Although further studies are needed for this special population regarding the impact on outcomes, providers should give cessation interventions high priority for diabetes control. This challenging population will need creative interventions to overcome their unique problems during smoking cessation, but the potential benefits may be considerable.