Bridging the Gap: Integrating Smoking Cessation Strategies into Diabetes Management

A survey of French diabetologists and smoking cessation specialists revealed significant gaps in their knowledge about the risks of smoking in diabetic patients, underscoring the urgent need for enhanced training and education. The study highlights the importance of integrating smoking cessation strategies into diabetes care to improve patient outcomes.

A recent survey conducted by the Working Group on Smoking and Diabetes, comprising researchers from several prominent French medical institutions, including the Department of Medical Pharmacology at Hopital Pitie-Salpetriere-Sorbonne University in Paris, the Cardio-Thoracic Department at Universite Champagne-Ardenne, and the Department of Endocrinology at Centre Hospitalier de Dijon, has highlighted significant gaps in the knowledge of French healthcare professionals regarding the relationship between tobacco smoking and diabetes. Published in Primary Care Diabetes, the study aimed to assess the awareness and practices of diabetologists and smoking cessation specialists (SCS) concerning smoking as a risk factor for diabetes and its complications.

Survey Reveals Knowledge Gaps Among Diabetologists

The online survey was distributed to members of the French Language Society of Diabetes (SFD) and the French Language Society on Tobacco (SFT), with a response rate of 23.2% from diabetologists and 31.5% from SCS. Among the respondents, 225 were diabetologists, and 97 were SCS. The survey revealed that while over 90% of diabetologists reported recording their patients' smoking status, there were significant gaps in their knowledge about the risks associated with smoking. Diabetologists generally understood that smoking increases all-cause mortality among individuals with diabetes, but only 29.3% were aware that smoking is a risk factor for type 2 diabetes, compared to 76.3% of SCS. Furthermore, only 32.9% of diabetologists recognized that smoking is associated with poor glycemic control, whereas 86.6% of SCS were aware of this fact. Awareness of smoking as a risk factor for microangiopathy was also lower among diabetologists (64%) compared to SCS (76.3%).

Prioritizing Smoking Cessation Over Glycemic Control

The survey results indicated that more diabetologists prioritized smoking cessation over optimizing glycemic control for type 2 diabetes patients (69.3%) than for type 1 diabetes patients (47.1%). Despite the high co-occurrence of smoking and diabetes, only a small percentage of both groups felt competent in treating smoking cessation among diabetic patients. Specifically, only 11.1% of diabetologists and 14.4% of SCS reported having received training in this area. This lack of training is concerning given that smoking is one of the major modifiable risk factors for mortality, poor glycemic control, and both macrovascular and microvascular complications in individuals with diabetes.

Urgent Need for Enhanced Training and Education

The study emphasized the need for improved education and training for diabetologists on the negative impacts of smoking on diabetes and the importance of smoking cessation. The findings suggest that healthcare professionals should be better equipped to support diabetic patients in quitting smoking to reduce the risk of complications and improve overall health outcomes. Given the significant health burden of diabetes and the well-documented risks of smoking, the integration of smoking cessation strategies into diabetes care is critical.

The Role of Healthcare Professionals in Smoking Cessation

The Working Group on Smoking and Diabetes, which initiated this survey, was formed under the auspices of the French Language Society of Diabetes and the French Language Society on Tobacco. The group had previously issued recommendations about the smoking-diabetes association and sought to compare the knowledge of diabetologists and SCS through this survey. Their findings underscore the need for targeted training programs to bridge the knowledge gap and ensure that all healthcare professionals involved in diabetes care are well-informed about the risks of smoking and the benefits of cessation.

Addressing a Global Health Challenge

This survey's strength lies in addressing a typically neglected but crucial topic, highlighting the need for more information among diabetologists about the adverse effects of smoking on diabetes risk and glycemic control. However, the study also has limitations, including a lower than expected response rate and potential selection bias, as the characteristics of respondents may differ from non-respondents. Despite these limitations, the survey provides valuable insights into the current state of knowledge and practice among French diabetologists and SCS, calling for urgent action to enhance training and support for smoking cessation in diabetes care.

The global prevalence of tobacco use and its co-occurrence with diabetes presents a significant public health challenge. According to the World Health Organization, there are 1.3 billion tobacco users worldwide, and data from 33 countries indicate that smoking prevalence among individuals with type 2 diabetes is 20.8%. In France, the prevalence of smoking among individuals with type 1 diabetes is 25.3%, higher than among those with type 2 diabetes (13.4%). These statistics highlight the urgent need for comprehensive strategies to address smoking in diabetes care.

The co-occurrence of smoking with diabetes is frequent and poses a substantial risk to individuals with diabetes. The survey's findings reveal that the knowledge about the smoking-diabetes association among diabetologists is insufficient, underscoring the necessity for enhanced training and education. Diabetologists, along with other healthcare providers such as nurses and dietitians, should be equipped with the knowledge and skills to help diabetic patients quit smoking. By integrating smoking cessation into diabetes care, healthcare professionals can significantly reduce the risk of complications and improve the overall health and well-being of individuals with diabetes.