Do "diabetics" need to "quit smoking"?

On May 31, 2021, we ushered in the 34th World No Tobacco Day.
This year's theme is "Commit to Quit".

According to my personal experience, compared with the attitude of the people in some countries to avoiding public smokers, the public in our country pays far less attention to the harm of tobacco.

Smoking only damages the respiratory system? The harm is far from this! With the deepening of research, people have discovered that smoking is an important risk factor leading to cancer, respiratory system and cardiovascular and cerebrovascular diseases, and it is also closely related to the occurrence and development of diabetes and its complications.

The management of diabetic patients with smoking has also been paid more and more attention.
For example, the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)" just released at the end of April has separately listed the relevant content of "Smoking cessation management for patients with type 2 diabetes" and the degree of importance It can be seen.

Regarding the "management of smoking cessation for diabetic patients", what recommendations have been made by authoritative guidelines/consensus at home and abroad? This article has been summarized.

 Recommendations in the ADA2021 Diabetes Diagnosis and Treatment Standards The fifth part of the ADA2021 Diabetes Diagnosis and Treatment Standards "Promote behavioral changes and mental health to improve health outcomes" is specifically recommended for diabetic patients to quit smoking: 5.
32 It is recommended that all patients do not use cigarettes and other tobacco products or electronics smoke.

A5.
33 After determining the use of tobacco or e-cigarettes, consider smoking cessation counseling and other forms of treatment as a routine part of diabetes care.

A5.
34 For patients in need, quit smoking as part of the diabetes education program.

B.
The results of epidemiology, case-control, and cohort studies provide convincing evidence to support the causal relationship between smoking and health risks.

Recent data shows that adults with chronic diseases and adolescents with diabetes have higher smoking rates.

Compared with non-smokers, smokers with diabetes (and diabetic patients exposed to second-hand smoke) have a higher risk of CVD disease, premature death, microvascular complications, and poorer blood sugar control.

Smoking may play a role in the development of type 2 diabetes.

Routine and thorough evaluation of tobacco use is essential to prevent smoking or encourage smoking cessation.

Many large randomized clinical trials have demonstrated the effectiveness and cost-effectiveness of simple counseling for smoking cessation in reducing smoking, including telephone cessation hotlines.

Medications that help diabetic patients quit smoking have been proven to be effective.
For patients who are motivated to quit smoking, it is more effective to add medication to the consultation than treatment alone.

Special consideration should include the assessment of the level of nicotine dependence, which is related to difficulty in quitting smoking and relapse.

Although some patients may gain weight shortly after quitting smoking, recent studies have shown that weight gain does not reduce the substantial cardiovascular benefits of quitting smoking.

A study of smokers newly diagnosed with type 2 diabetes found that smoking cessation was associated with improvements in metabolic parameters, as well as reductions in blood pressure and proteinuria in the following year.

In recent years, e-cigarettes have gained public attention and welcome because it is believed that the use of e-cigarettes is less harmful than regular smoking.

However, based on recent evidence from the Centers for Disease Control and Prevention on the use of e-cigarettes to cause death, no one should be advised to use e-cigarettes, either as a way to quit smoking or as a recreational drug.

Diabetes education programs provide the possibility of systematically reaching out to people with diabetes and involving them in smoking cessation efforts.

A cluster randomized trial found that, regardless of the initial motivation to quit, smoking cessation rates and long-term smoking cessation rates (>6 months) were statistically significantly increased through the smoking cessation interventions provided by diabetes education clinics.

(Translation: Zhang Xiaomeng/Shijiazhuang City People's Hospital) Recommended points in the 2020 China Type 2 Diabetes Prevention and Control Guide: ➤It is recommended that all diabetic patients do not smoke and use other tobacco products and electronic cigarettes, and minimize second-hand smoke exposure.

(A) ➤For diabetic patients who smoke and use e-cigarettes, smoking cessation counseling and other forms of treatment should be included in routine diabetes diagnosis and care.

(A) 1.
The harms of smoking and the benefits of quitting smoking.
Smoking is harmful to your health.

Smoking is not only an important risk factor leading to cancer, respiratory system and cardiovascular and cerebrovascular diseases, but also closely related to the occurrence and development of diabetes and its complications.

In a large-scale prospective study of the Chinese population, it was found that the risk of diabetes in men who smoked in the city was 1.
18 times that of non-smokers, and the younger they started smoking, the greater the amount of smoking and the higher the risk of diabetes.

A cross-sectional study involving more than 6000 diabetic patients showed that smoking is an independent risk factor for elevated glycosylated hemoglobin (HbA1c).
For every 20 packs/year increase in smoking, HbA1c increased by 0.
12%.

In addition, parental smoking (passive smoking) increases the risk of obesity and insulin resistance in children and adolescents.

Smoking can also increase the occurrence of various complications of diabetes.
Smoking also increases the risk of various complications of diabetes, especially macrovascular disease.

A meta-analysis of 46 prospective studies showed that smoking can increase the risk of all-cause death in diabetic patients by 48%, the risk of coronary heart disease by 54%, the risk of stroke by 44%, and the risk of myocardial infarction by 52%.

Smoking can also damage the structure and function of the glomerulus, increase urine protein and diabetic nephropathy.

In recent years, electronic cigarettes have gained public attention and welcome, but electronic cigarettes may cause lung damage, vascular endothelial dysfunction, and oxidative stress.

Quitting smoking can significantly reduce the incidence of cardiovascular disease and all-cause mortality.

Quitting smoking can also delay the development of diabetic nephropathy.

Quitting smoking can increase the level of high-density lipoprotein cholesterol and lower the low-density lipoprotein cholesterol, thereby helping to prevent diabetes complications.

Although studies have shown that smoking cessation can lead to weight gain and blood sugar increase in type 2 diabetes (T2DM) patients in the short term, this effect will gradually weaken over time and will disappear after 3 to 5 years.
It cannot hide the effect of smoking cessation.
The beneficial effects and long-term benefits of diabetic patients.

An epidemiological survey in Chinese male T2DM patients showed that with the increase in smoking, fasting blood glucose and HbA1c both showed an upward trend, while among ex-smokers, with the increase in smoking cessation years, fasting blood glucose and HbA1c were gradually increased.
Decrease, quitting smoking for more than 10 years can reduce fasting blood glucose and HbA1c levels by 0.
44 mmol/L and 0.
41%, respectively.

 2.
Measures and precautions for smoking cessation Diabetic patients often suffer from hunger-prone symptoms.
After smoking cessation, the appetite suppressing effect of nicotine is relieved, and eating increases can cause weight gain.

Quitting smoking also changes the intestinal flora and can also lead to weight gain.

However, the adverse effects of weight gain cannot offset the beneficial effects of quitting smoking.

Therefore, physicians should encourage patients to quit smoking and pay attention to weight management during smoking cessation.

Smoking cessation measures include behavioral intervention and drug intervention.

 Behavioral interventions include: ➤ Regular education for patients with diabetes, informing patients of the harms of smoking, adverse effects on diabetes, benefits of quitting smoking, and smoking cessation measures, etc.
; ➤ Opening of short-term consultations and smoking cessation hotlines to patients for smoking cessation; ➤ Evaluating the smoking cessation of patients State and nicotine dependence level, so as to formulate corresponding smoking cessation goals; ➤ Provide patients with psychological and behavioral support, including group support from family members, friends or patients, and develop individualized diet and exercise treatment programs and smoking cessation plans for patients, and regularly Follow-up; ➤For those who have successfully quit smoking, follow-up for 6 to 12 months (such as phone calls) can help prevent relapse.

 Drug intervention can use nicotine replacement therapy, bupropion, varenicline and other drugs to help patients quit smoking.
These drugs can increase the success rate of smoking cessation and can be used under the guidance of smoking cessation experts.

In addition, these drug interventions may delay weight gain after smoking cessation.

Therefore, quitters can focus on quitting smoking first and then on weight management.

In addition, the use of metformin, sodium-glucose cotransporter 2 inhibitor (SGLT2i), glucagon-like peptide-1 receptor agonist (GLP-1RA) and other hypoglycemic drugs that can help reduce weight are used in the treatment of diabetes.
At the same time, it helps to suppress weight gain after quitting smoking.

Compared with minimal intervention or routine care, combined medication and behavioral intervention can increase the success rate of smoking cessation to 70% to 100%.

Reference materials: [1] Diabetes Branch of Chinese Medical Association, Chinese Type 2 Diabetes Prevention Guidelines (2020 Edition) [J].
Chinese Journal of Diabetes, 2021, 13 (4): 315-409.
DOI: 10.
3760/cma.
j.
cn115791-20210221-00095.
[2].
Chen Kang.
Consensus guidelines｜Contents about quitting smoking for diabetic patients** (World No Tobacco Day).
CK Medical Science.
2021.
5.
31.