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5.7 Tobacco Cessation

Tobacco smoking increases risk of macrovascular complications 4-400% in adults with T2DM and also increases risk of microvascular complications. Over time, tobacco and nicotine products have expanded (including e-cigarettes, water pipes and dissolvable products) and care teams should be advised about these developments in order to screen and counsel appropriately.  Tobacco cessation is very likely to be the single most beneficial intervention that is available, and it should be emphasized by clinicians as described below.

  • Identify and document tobacco use status.
  • Treat every tobacco user. If the patient is unwilling, the clinician should implement motivational treatments.
  • Individual, group and telephone counseling are effective, and their effectiveness increases with treatment intensity.
  • Practical counseling (problem-solving/skills training and social support delivered as part of the treatment) is an especially effective counseling strategy and should be implemented by clinicians.
  • Numerous effective pharmacotherapies for smoking cessation now exist. Except in the presence of contraindications, these may be used with all patients attempting to quit smoking. Please see the ICSI Healthy Lifestyles guideline for additional information.
  • The combination of counseling and medication is more effective than either alone. Therefore, clinicians should encourage all individuals making a quit attempt to use both.
  • Telephone quitline counseling is effective. Therefore, clinicians and health care delivery systems should ensure patient access to quitlines and promote their use. HHS National Quitline (1-800-QUITNOW) or 1-800-784-8669 connects you to counseling and information about quitting smoking in your state.
  • Tobacco dependence treatments are both clinically effective and cost effective. Effective interventions require coordinated interventions.  Just as the clinician must intervene with the patient, so must the health care administrator, insurer and purchaser foster and support tobacco intervention as an integral element of health care delivery.