Emerging guidelines from the DiaSmokeFree Working Group highlight that stopping tobacco use must be a core component of diabetes management, as smoking significantly worsens health outcomes for those with type 2 diabetes.
For people with type 2 diabetes, smoking is not a side issue. It raises the risk of heart disease, stroke, kidney damage and other vascular complications, and it can also make blood sugar harder to control. The Indian Express reported on new consensus guidance from the DiaSmokeFree Working Group, which argues that stopping tobacco use should be treated as a core part of diabetes care rather than an optional lifestyle goal.
Dr Anoop Misra, one of the authors and executive chairman of Fortis C-Doc for Diabetes and Allied Sciences, said India faces a heavy burden of both smoking and smokeless tobacco. He pointed to Global Adult Tobacco Survey data from 2016-17 showing that 28.6% of adults used tobacco in some form. The Centres for Disease Control and Prevention says smoking increases the risk of type 2 diabetes by 30% to 40%, while the US Food and Drug Administration says the chemicals in cigarette smoke can make insulin less effective and worsen blood sugar control.
The recommendations move beyond simple advice to quit. They call for a structured approach that combines counselling, medication and relapse prevention, with treatment tailored to how ready each person is to stop. According to the Indian Express, varenicline is the preferred first-line drug when available and suitable, while nicotine replacement therapy and bupropion are reasonable alternatives. The evidence base for these medicines in people with type 2 diabetes remains limited, however, which is why the authors say more research is needed.
The guidance also stresses that quitting can trigger temporary changes that clinicians need to manage. Blood sugar may shift after stopping smoking, and weight gain is common enough to warrant advance planning. The CDC advises closer glucose monitoring after quitting, and the Indian Express report says follow-up within two and four weeks can help doctors track glycaemic control, blood pressure, weight and any need to adjust other medicines.
There are also wider treatment implications. The report notes that cigarette smoke can alter drug metabolism, so stopping may change exposure to some medicines and require dose review. Researchers are exploring whether diabetes drugs such as GLP-1 receptor agonists might also help people quit smoking, but evidence is inconsistent: a small study of exenatide showed benefit when paired with nicotine replacement, while a larger trial of dulaglutide did not. For now, the clearest message from the guidance is that smoking cessation should be built into routine diabetes management, including in low- and middle-income countries where access to specialist support can be limited.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
