Then set a quit date to begin your smoke-free lifestyle. Share that date with friends and family members who can support you and help hold you accountable. Some of them may even want to join you on your journey! Many people find that quitting cold turkey is the best way to stop. You might find it easier to quit gradually by decreasing the amount of cigarettes you smoke each day.
Whatever method you choose, your doctor can provide tips to help you along the way. They can also prescribe medications or recommend over-the-counter aids, such nicotine patches or gum. They may also encourage you to try smoking cessation counseling or alternative treatments, such as hypnosis or acupuncture. Remember, nicotine raises your blood sugar. If you use smoking cessation aids that contain nicotine, such as nicotine patches or gum, your blood sugar will remain elevated.
Over time, you can wean yourself off of these aids and enjoy the benefits of lower blood sugar. For more information and help, call the U. Having diabetes raises your risk of many health problems. Why add fuel to the fire by smoking? Avoiding tobacco products lowers your risk of complications from diabetes. It can help you limit the damage to your organs, blood vessels, and nerves. This can help you live a longer and healthier life. If you currently smoke, recognizing the benefits of quitting is an important first step.
Make an appointment with your doctor to learn about the treatment and support options that can help you quit for good. On top of lung diseases, smoking can cause poor vision, premature aging, and more. Learn what happens to your body when you smoke. State and federal health authorities in the United States are now investigating more than vaping-related lung illnesses, with one death reported….
Vaping when you have asthma can exacerbate your asthma symptoms and may cause other side effects. If you are vaping to help you quit smoking, it could….
While you can't totally clean your lungs, there are many things you can do to improve your lung health after quitting smoking. These findings concur with the results of an earlier meta-analysis on 46 studies that showed a higher risk of total mortality as well as cardiovascular outcomes, and for CHD than other events in patients with diabetes [ 19 ].
Moreover, a decreasing trend was observed in smoking quitters [ 19 ]. Recently three studies have corroborated these findings. In one, a cohort study conducted on a large population from the Swedish National Diabetes Register, smoking was one of the five strongest predictors of death and acute myocardial infarction among patients with T2DM; the other predictors are glycated hemoglobin, systolic blood pressure, LDL cholesterol, and physical activity [ 43 ]. In the third study, a large prospective cohort study assessed the risk of CHD incidence and mortality, and all-cause mortality in Finnish people with and without T2DM according to smoking status [ 45 ].
The risk of CHD in T2DM patients who had stopped smoking was still significantly higher than in their non-smoking non-diabetic counterparts, but lower than in T2DM patients who still smoked. Similar results were observed for all-cause mortality data [ 45 ]. These studies make it clear that the risk for macrovascular complications is higher for patients with diabetes who smoke than those who do not.
As opposed to the quantity of research available on macrovascular complication, few studies have examined the relationship between smoking and microvascular complications such as nephropathy, retinopathy and neuropathy. The results of the studies are not entirely consistent, in particular for T2DM.
Diabetic nephropathy is a clinical syndrome characterized by persistent albuminuria, progressive decline in the glomerular filtration rate GFR , peripheral edema, and elevated arterial blood pressure. It is one of the most severe complications in patients with diabetes, and it is considered a major cause of end-stage renal failure [ 46 , 47 ].
There is accumulating evidence that smoking increases the risk of incidence and progression of nephropathy in people with diabetes, and particularly in those with T1DM [ 48 , 49 , 50 , 51 ]. In a 4-year prospective study of T1DM patients with normoalbuminuria at baseline, Scott et al. Feodoroff and colleagues explored the effect of smoking on development and progression of diabetic nephropathy expressed as year cumulative risk of microalbuminuria, macroalbuminuria and end-stage renal disease in a large cohort of patients with T1DM from a prospective Finnish Diabetic Nephropathy study [ 53 ].
The authors reported active smoking as a risk factor for progression of diabetic nephropathy with a dose-dependent risk increase. For those who quit smoking their risk for the development and progression of diabetic nephropathy was the same as for nonsmokers after multivariable adjustment [ 53 ].
Other evidence on the association between smoking and diabetic nephropathy in T2DM is inconclusive. A similar gender-dependent association was reported by Briganti and colleagues for male patients with high-normal systolic blood pressure or with high-normal 2-h glucose levels [ 55 ].
A more rapid progression of diabetic nephropathy has been observed more frequently in smokers with T2DM compared to non-smoking patients [ 56 , 57 , 58 , 59 ]. A study conducted on Taiwanese men showed a clear dose—response effect of cigarette smoking on the development of proteinuria in males with T2DM [ 60 ]. Compared with non-smokers, those who had smoked 15—30 or more than 30 pack-years were respectively 2. The dose—response effect of tobacco exposure on the development of proteinuria was highly significant in all patients, including subgroups with a relatively short duration of DM, optimal blood pressure control, and those of young age.
Progression of microalbuminuria to overt proteinuria and subsequent terminal renal failure were higher in smokers than in non-smokers. A recent meta-analysis of 21 studies assessed the impact of smoking on diabetic nephropathy and reported that smoking was a statistically significant risk factor for diabetic nephropathy with an OR of 1. A recent meta-analysis of 20, patients with T2DM found that the odds ratio OR of smokers developing albuminuria compared to non-smokers was 2.
The role of smoking as a potential risk factor for diabetic retinopathy has been established in patients with type 1 DM [ 62 , 63 ], but its role is disputed in patients with T2DM, with many studies reporting no association or even a decreased risk of developing retinopathy in smokers [ 64 , 65 , 66 , 67 , 68 , 69 ]. In the 4-year and year follow-up of the Wisconsin Epidemiologic Study of Diabetic Retinopathy, smoking was not significantly associated with the risk of incidence and progression of diabetic retinopathy [ 67 ].
In the study, the progression of vasculopathy was much less rapid in smokers compared with non-smokers among the patients who had diabetic retinopathy at the beginning of the study. This discordant evidence that—compared to non-smokers—the risk of diabetic retinopathy is significantly increased in smokers with T1DM while significantly decreased in smokers with T2DM has been also confirmed recently in a meta-analysis of 73 studies [ 70 ].
The association between smoking and the risk of diabetic neuropathy has been examined in two important articles. In the European Diabetes Prospective Complications Study, neuropathy was assessed at baseline and after a 7. The second article, a systematic review of 10 prospective cohort and 28 cross-sectional studies [ 72 ], evaluated the development of diabetic neuropathy in a total population of patients.
Over a period of 2 to 10 years, new cases of diabetic neuropathy were observed; the OR for neuropathy among smokers was not significantly higher. These discrepancies could be the result of the poor sensitivity of common methods of neuropathy testing [ 73 , 74 ].
Of interest, Ahmad and colleagues [ 75 ], by using more sensitive and specific nerve conduction studies, were able to show that smoking was an independent risk factor for manifestations of neuropathy in patients with T2DM, with heavy smokers exhibiting worse nerve conduction.
The studies on smoking and its effects on microvascular effects can seem to present a confusing relationship until other factors are considered. The impact of smoking on these conditions varies by the type of diabetes, DM or T2DM, and by gender as well.
Overall, very few rigorous prospective studies are available, and, as is too often the case, more research is necessary. The effect of smoking on glycemic control in people with diabetes is poorly studied with often contradictory results.
Cigarette smoking worsens insulin-resistance in patients with diabetes [ 76 ]; consequently, quitting smoking should improve glycemic control. Yet, smoking cessation often results in worsened glycaemic control, possibly due to the weight gain that frequently occurs after smoking abstinence [ 77 ]. A Japanese study of 25 patients with diabetes who smoke indicated poorer glycemic control in those who quit compared to patients who continued to smoke [ 78 ].
The effects of continued smoking in the data from the Fukuoka Diabetes Registry [ 81 ] and the Swedish National Diabetes Registry [ 82 ] showed that HbA1c levels progressively increased with the number of cigarettes smoked per day. Notwithstanding other studies have not confirmed any association between smoking and glycemic control [ 76 , 83 ]. In another cohort study of 10, men and 15, Chinese women with DM, smoking was associated with an increased risk OR of 1.
The relationship is dose-dependent and independent of traditional confounding factors, including sociodemographic and lifestyle factors. The increased risk for poor glycemic control compared to non-smokers normalized only after at least 10 years of abstinence from smoking.
Another study conducted in China [ 85 ] on male patients with T2DM found that cigarette smoking was associated with increased level in fasting plasma glucose and HbA1c, particularly in treated patients with highest smoking duration and pack-years. Compared to non-smokers, average HbA1c increase was 0. These inconsistent results could be explained by the differences in the study populations.
The discrepancies may be caused by confounding factors, in particular, known lifestyle risk factors that were not examined in some of the studies. Quitting smoking, shows clear benefits in terms of reduction or slowing of the risk for cardiovascular morbidity and mortality in people with diabetes as it does for the general population [ 86 , 87 ].
The large meta-analysis by Pan and colleagues [ 20 ] discussed earlier has shown that patients who quit smoking have a lower cardiovascular risk compared to smokers. In T2DM patients, smoking cessation is known to decrease both short- and long-term CVD risk, even independently from weight gain [ 88 , 89 ]. More recently, a descriptive analysis of Spanish patients with T2DM smokers and former-smokers performed in a cross-sectional, multicenter, nationwide study, assessed the estimated likelihood of CHD risk at 10 years according to the UKPDS score in patients with diabetes [ 91 ].
The estimated risk of developing CHD was significantly greater in smokers compared with former-smokers. The promising finding from a nephropathy study demonstrated the quitting smoking reduced the risk of that complication to that of a never smoker. Still for evidence on microvascular complications, the studies are limited and not conclusive. For instance, two studies have shown that smoking cessation among patients with diabetic nephropathy improved the progression of existing nephropathy [ 18 , 59 ], but its impact on newly developing diabetic nephropathy has been infrequently studied with prospective research designs.
The evidence supporting the position that quitting smoking can lower the risk of macrovascular complications among patients with diabetes is sound. We can be sure that quitting can break-up that dangerous liaison. On the other hand, the impact of smoking cessation on the risk of microvascular complications remains without clarity, a set of confusing relationships.
Further prospective studies will be needed to document and quantify the decreasing of risk of complications in patients with diabetes who stop smoking. Abstinence from smoking will certainly produce specific benefits in patients with diabetes. This fact is reflected in the most recent guidelines on diabetes treatment [ 21 , 92 ] which include smoking cessation as a key chapter. Current guidance highlights the importance of stopping smoking for patients with diabetes to achieve a better quality of life and to delay the onset and progression of diabetes complications.
The currently available smoking cessation therapies have been shown to double or even triple the dropout rates in controlled studies [ 93 , 94 ]. A recent study in patients with DM yielded a smoking cessation rate of However, according to a survey by Diabetes UK, Another constraint to cessation treatment is the absence of a convincing demonstration of an effective cessation interventions in patients with DM [ 97 ].
Further studies will be needed to provide clear evidence that which interventions can be valuable for these patients. As a consequence the smoking prevalence among patients with DM continues to be similar to that found in the general population with a significantly less marked decrease trend in patients with diabetes compared to the general population [ 22 , 23 , 98 , 99 ].
These conditions mean that helping patients with diabetes to quit requires a greater commitment and the use of personalized anti-smoking strategies. Given the high risk for relapse, successful and prolonged smoking abstinence can be challenging. Psychological support appears to be a central component of treatment. Combining personalized psychological support with standard pharmacological medications can achieve the best possible results [ , ].
Patients with diabetes who smoke should be routinely reminded that cigarette smoking increases their risk of developing disease complications, adversely affects their blood glucose control and increases their insulin-resistance. For treatment, the first line drugs used to increase the likelihood of success in smoking cessation include nicotine replacement therapy NRT , bupropion and varenicline [ , ], discussed below.
NRT is available in different formulations: chewing gum, inhalers, lozenges, sprays and transdermal patches. Their main mechanism of action is that of replacing the nicotine delivered by cigarette smoking, thus decreasing the severity of withdrawal symptoms and helping the smoker to quit [ ]. Different formulations may have a distinct impact on withdrawal symptoms or on the urge to smoke, but whether one formulation is more effective than another is open to debate.
Nonetheless, NRT-based treatment doubles the chances of success in quitting smoking, regardless of the specific formulation [ , , ]. Although not formally regulated as a pharmaceutical product, electronic cigarettes are nicotinic substitutes. They are battery-powered devices that vaporize the nicotine present in the refill liquid of electronic cigarettes and, like NRT, are able to lower the severity of withdrawal symptoms [ , ].
Randomized clinical trials support the efficacy and safety of these devices [ , , ]. In particular, a recent RCT has demonstrated that electronic cigarettes are on average twice as effective as NRT for smoking cessation [ ]. Nicotinic substitutes—by virtue of the known effects on sympathetic neural stimulation and catecholamine release—can have a negative impact on the cardiovascular system and on glucose metabolism [ , ]. Some authors have raised concerns about NRTs use in DM patients with poor glyco-metabolic control given that nicotine may increase insulin-resistance [ , ].
Therefore, clinicians must consider the possibility of clinical-metabolic worsening of DM and its complications during NRT therapy. Some studies have shown an association between the use of NRT and reporting of serious cardiovascular events e. Two meta-analyses investigating adverse events associated with NRTs have shown increased cardiovascular symptoms including tachycardia and chest pain [ , ], but not major cardiovascular events cardiovascular death, non-fatal myocardial infarction and non-fatal stroke [ ].
A cohort study of 50, smokers who tried to quit smoking [ ] with 4-weeks use of NRT did not find any impact on cardiovascular risk. Although no specific recommendations for smokers with DM are available, it is reasonable to limit the use of NRT over time.
Buproprion was initially developed and marketed as an antidepressant, but it has become the first oral treatment without nicotine approved for smoking cessation. It inhibits the re-uptake of norepinephrine and dopamine at the level of neuronal synapses in the central nervous system, acting as a non-competitive antagonist of nicotine receptors.
In a Cochrane review, bupropion doubles the odds of quitting smoking compared to placebo, with or without co-occurring depression [ ]. The cessation rates for bupropion treatment are practically similar to those obtained with NRT [ ].
Bupropion was determined to be safe in patients with cardiovascular disease, although occasional increases in blood pressure have been reported in smokers with hypertension [ ].
Although no studies are available in patients with DM, the use of bupropion can be considered safe for these patients. A plus for this treatment is that bupropion is able to limit the weight gain that often occurs when smoking is stopped, as demonstrated in RCTs [ , ].
Bupropion could therefore be proposed as a treatment of choice in obese patients with diabetes. Another cessation treatment is varenicline. Many RCTs have confirmed the efficacy of varenicline. A Cochrane review concluded that varenicline more than doubles the odds of quitting smoking compared to placebo [ ].
Furthermore, varenicline showed its greater efficacy compared to any form of bupropion monotherapy or with NRT [ , ]. When compared to NRT combination therapy, varenicline significantly increases the success rate in the short and medium term, but not in the long term [ , ]. The results raise questions about the relative effectiveness of intense smoking pharmacotherapies.
The safety profile, varenecline appears to be safe and well tolerated by patients with DM. A retrospective analysis of data obtained from participants in 15 randomized clinical trials with varenecline showed that the distribution of the number of adverse events in patients with DM mainly nausea and headache was comparable to that of participants without diabetes [ ].
The complex interaction between smoking and DM poses multiple challenges for the researcher, the clinician and the patient. Current evidence shows that regular smoking is an important risk factor for cardiovascular morbidity and mortality in patients with diabetes. Although the role of smoking and the impact of smoking cessation on microvascular complications has not been fully clarified, stopping smoking must remain a primary goal for people with diabetes to decrease their risk for macrovascular complications.
Given that not all smokers with DM are susceptible to the detrimental effects of cigarette smoke, searching key phenotypic predictors for this vulnerability may be an important area for future investigation. The increased recognition that regular smoking and DM is a dangerous liaison albeit with confusing relationships should stimulate greater efforts to develop effective smoking cessation programs and encourage avoidance strategies.
The high smoking prevalence among patients with diabetes, their poor level of glyco-metabolic control and their low success rates of stopping smoking all highlight the importance of systematically counseling smokers with DM of the numerous risks of smoking.
Doctors and healthcare providers therefore have a duty to alert their patients with diabetes about the additional burden of risks of caused by smoking. The message must be strong and personalized. Physicians should evaluate the need to prescribe drugs for the treatment of nicotine addiction to decrease nicotine withdrawal symptoms that may occur: dysphoric or depressed mood, irritability, frustration or anger, anxiety and restlessness, increased cough, increased appetite, weight gain, sense of weakness and constipation.
Physicians should not hesitate to refer these patients to a specialized center and follow-up on their course of treatment. Alas, the solid bond with cigarette smoking creates a huge obstacle for the smoker, even for those who have a strong desire to quit, so much so that several attempts and treatments must be attempted before obtaining a lasting abstinence.
Where success has not be achieved, clinicians should consider alternative strategies including those based on risk reduction by using the new emerging technological devices without combustion e.
Although, little is known about the health effects of long-term vaping or heated tobacco systems, we know for sure that long-term consumption of combustible cigarette is deadly liasion and can lead to the development of diabetes and other metabolic alterations. The recent outbreak of severe acute respiratory illnesses among several hundred US young adults and teens is NOT linked to commercial nicotine vaping products; the evidence is mounting that the actual source of these illnesses is the consumption of some illegal, black market THC carts cartridges containing dangerous adulterants as recently stated by the FDA [ ].
Given that many patients with diabetes continue smoking despite the well-known health risks, these emerging technologies for nicotine delivery could be a viable and much less harmful alternative.
We are aware of only one paper investigating the impact of e-cigarette use in diabetes. A large Internet-based survey of regular e-cigarette users with diabetes [ ] found that More studies in smokers with diabetes will be required to confirm these initial findings.
Smoking and diabetes presents both a dangerous liaison and confusing relationships. While we wait for further research for more evidence, promoting smoking cessation for those with DM deserves to be a top priority. Encouraging all smokers to quit may reduce the number of cases of DM overall.
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Department of Health and Human Services. How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease: a report of the surgeon general. Atlanta: U. The health benefits of smoking cessation.
Public Health Service. Centers for Disease Control. Office on Smohing and Health. CDC International Agency for Research on Cancer. Tobacco control: reversal of risk after quitting smoking. International Agency for Research on Cancer Worldwide trends in diabetes since.
A pooled analysis of population-based studies with 4. Google Scholar. Global Report on Diabetes. Fowler MJ. Microvascular and macrovascular complications of diabetes. Clin Diabetes. Article Google Scholar. Type 2 diabetes can be prevented or delayed with healthy lifestyle changes, such as losing weight, eating healthy food, and being active. If you have diabetes and you smoke, you are more likely to have serious health problems from diabetes, including: 3 Heart disease Kidney disease Poor blood flow in the legs and feet that can lead to infections, ulcers, and possible amputation removal of a body part by surgery, such as toes or feet Retinopathy an eye disease that can cause blindness Peripheral neuropathy damaged nerves to the arms and legs that cause numbness, pain, weakness, and poor coordination If you have diabetes and you smoke, quitting smoking will benefit your health right away.
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