Smoking and Diabetes: Helping Patients Quit

Cigarette smoking is the most important cause of preventable morbidity and mortality around the world. In the United States, smoking is responsible for one in five deaths. It costs the economy > $167 million in yearly health care costs and lost productivity. In 2004, an estimated 20.9% of people ≥ 18 years of age, equaling 44.5 million people, were current smokers. The prevalence of smoking in the United States decreased 40% between 1965 and 1990 but has remained level thereafter. Additionally, smoking rates have increased in people aged 18-24 years recently, which may indicate higher initiation rates of smoking in young adults.¹

The prevalence of smoking in patients with diabetes is similar to that in the general population, but the health repercussions are more severe.² Cigarette smoking has been shown to increase the risk of cardiovascular disease (CVD) more in patients with diabetes than in those without diabetes, and CVD is responsible for 65% of deaths in patients with diabetes.^3-6 Smoking also increases the risk of peripheral vascular disease and resultant amputations.⁷ In addition to increasing the risk of macrovascular disease in patients with diabetes, smoking cigarettes increases the risk of microvascular disease, contributing to nephropathy, retinopathy, and neuropathy.^2,8-11

Quitting smoking reduces the risk of mortality in patients with diabetes who smoke, but the risk of mortality is correlated with the duration of smoking, highlighting the importance of addressing the issue of smoking in all patients with diabetes.¹² To reduce the burden of illness from smoking, health professionals should encourage smoking cessation. In this report, we outline techniques for helping patients quit.

Our approach is based on the transtheoretical, or “stages of change,” model. The transtheoretical model of change is a principle of change management that places …