Diabetes Forecast June 2004
FOR TYPE 1/TYPE 2
Standards of Care
Smoking & Diabetes
Helping Smokers Quit
By Shauna S. Roberts, PHD
The American Diabetes Association regularly develops and updates guidelines for doctors who treat diabetes. Each month, one of these clinical practice guidelines will be discussed, to provide you with an inside look at all the latest ADA recommendations.
"Smoking and Diabetes" advises doctors how to help their patients stop smoking.
Background. Twenty percent of deaths in the United States can be attributed to cigarettes. Cigarette smoking kills more than 400,000 people each year. Smoking takes an extra heavy toll on people with diabetes. For example:
- Smoking appears to make cells less responsive to insulin. As a result, cells do not take enough glucose out of the blood.
- Smoking raises the already heightened risk of death from heart disease in people with type 2 diabetes.
- People with diabetes who smoke are more likely to develop diabetic nerve disease, kidney disease, and possibly eye disease.
Quitting smoking has many benefits. It reduces the risk of heart and blood vessel disease, stroke, cancer, lung disease, and presumably diabetes complications. So why don't people quit?
Nicotine is highly addictive. After a person inhales nicotine, it hits the brain in only seven seconds, where it dampens anxiety and creates a feeling of euphoria. The double whammy of physical and psychological effects makes quitting hard.
ADA believes that health care providers have not paid enough attention to helping people quit smoking. For example, one study found that only about half of people with diabetes who smoke had been advised to quit by their primary care physician. Yet quitting smoking is safe for everyone with diabetes.
Recommendations. Good diabetes care should include helping nonsmokers stay off cigarettes and helping current smokers quit. ADA suggests that doctors incorporate six components into their practice: ask, assess, advise, assist, arrange, and organize the clinic.
Ask. At every medical visit, the doctor should ask the patient whether he or she smokes.
Assess. Smokers vary greatly regarding how they feel about quitting. Some are tired of being chained to a costly habit that has become socially unacceptable. Others are happy to keep smoking forever. Doctors should judge how ready each smoker is to quit. One way is to ask the smoker whether he or she is ready to quit in the next 30 days or in the next six months. Different techniques are needed to help people at different stages of readiness to quit.
Advise. The doctor should routinely advise people under 21 years old not to smoke or use other tobacco products. For people who already smoke, the doctor should routinely advise them how important it is to quit. The message should be delivered clearly and strongly, personalized to each patient. It should include information on the usual risks of smoking and the added risks that occur when someone has diabetes.
Assist. If a person is willing to quit, the doctor should provide help in doing so. This may include helping the person choose a quitting date, advising how to prepare for the quitting date, and offering counseling or drugs. Drug therapies include four to six weeks of bupropion (Zyban), nortriptyline (Pamelor, Aventyl HCl Pulvules), or nicotine replacement therapy such as nicotine patches (Habitrol, Nicoderm CQ, and Nicotrol), gums (Nicorette), inhalers (Nicotrol), lozenges (Commit), and nasal spray (Nicotrol NS).
Arrange. Soon after the quit date, someone from the doctor's office should call the patient and follow up on his or her progress. If the person is taking a drug to help stop smoking, a follow-up appointment should be scheduled.
Organize the clinic. The doctor should organize his or her office so that the previous steps are integrated into the office routine. For example, smoking status can be noted at the same time that temperature and blood pressure are. There should be office staff who are trained to give support and follow-up to smokers who wish to quit.
Shauna S. Roberts, PhD, is a science and medical writer in New Orleans.
