Quitting smoking just got a dedicated playbook for diabetes patients

A new 80-page international consensus statement from the DiaSmokeFree Working Group is pushing for a major shift in how clinicians approach smoking in people with type 2 diabetes (T2D). Published in Diabetes Research and Clinical Practice, the document argues that smoking cessation has long been under-prioritized in diabetes care — with most major diabetes organizations offering little more than a brief "don't smoke" recommendation, and no structured pathway for pharmacotherapy, behavioral support, or metabolic monitoring.

The guidelines call for smoking status to be included in every diabetes risk assessment and for cessation to be treated as a key intervention to prevent cardiovascular complications. Varenicline is recommended as the first-line pharmacotherapy, with nicotine replacement therapy or bupropion as alternatives when varenicline isn't accessible.

Key Takeaways:

• Screen for smoking at every clinical visit and incorporate smoking status into diabetes risk tools
• Varenicline is first-line; NRT or bupropion are alternatives if unavailable
• Tobacco smoke alters metabolism of pioglitazone, dapagliflozin, and canagliflozin — doses may need adjustment after quitting
• Bupropion or nicotine co-administered with metformin or linagliptin can raise plasma drug levels, requiring dose review
• Monitor glucose, blood pressure, and weight closely in the post-cessation period

Why it matters: With T2D patients already at elevated cardiovascular risk, smoking remains one of the most impactful — and addressable — modifiable risk factors. This guidance gives clinicians a practical, structured framework to finally treat cessation as the clinical priority it deserves.