Stroke, heart attacks, neuropathies, retinopathies, diabetic nephropathies: choosing to smoke exacerbates the clinical picture of patients with diabetes. But can quitting change a critical health situation? According to the latest research by the DIASMOKE group, the pool of international experts coordinated by COEHAR, giving up cigarettes offers significant benefits in managing diabetes complications, reducing the risk of complex diseases.

LINK to the review

With over 537 million adults worldwide, diabetes mellitus is one of the most prevalent diseases, leading to the onset of microvascular and macrovascular complications, including diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, heart attacks, and strokes.

“Unfortunately, we cannot simply consider diabetes management as only affecting the onset or course of the disease. There are risk factors related to specific habits that worsen the patient’s clinical picture, increasing the risk of complications. Among these, cigarette smoking is one of the main factors that must be kept under control and addressed with targeted treatments”- explains Magdalena Walicka, from the Mossakowski Medical Research Centre of Varsavia. 

The international research group of DIASMOKE, composed of some of the world’s leading experts in diabetology and coordinated by CoEHAR in Catania, studies the complex interactions between the toxic components developed from cigarette smoke and diabetes management, also evaluating the impact of cessation paths on the course of the disease and the effectiveness of antidiabetic treatments.

The review “Influence of quitting smoking on diabetes-related complications: A scoping review with a systematic search strategy” published today is the first to provide a detailed analysis supported by scientific evidence on the influence of cessation paths on the complications of the disease in patients with type 2 diabetes.

Researchers identified a total of 1023 studies. Only 26 met the criteria for eligibility. A total of 16 studies was included for cardiovascular outcomes, 6 for nephropathy, 2 for retinopathy, 2 for neuropathy and 3 for diabetic foot and erectile dysfunction.

Research suggests that smoking cessation can have significant benefits in reducing the risk of cardiovascular events among individuals with type 2 diabetes. Former smokers generally exhibit a lower risk of coronary heart disease compared to current smokers, although their risk remains higher than that of non-smoking, non-diabetic individuals. However, while some studies show a significant decrease in myocardial infarction and ischemic stroke risks among quitters, others do not find a significant effect, possibly due to factors such as study duration and changes in weight post-cessation. Notably, the age at which one stops smoking plays a crucial role: the sooner, the better.

Regarding microvascular complications, researchers have found mixed results. The strongest evidence found by the DIASMOKE group pertains to diabetic nephropathy, a condition characterized by persistent albuminuria and a progressive decline in renal function.Quitting smoking leads to a significant reduction in the risk of developing this condition and an improvement in renal function over time.

However, the relationship between smoking and other diabetic complications, such as retinopathy and neuropathy, is poorly investigated and remains unclear, highlighting the need for additional research to fully understand these associations.

Smoking has been linked to the exacerbation of diabetic foot complications, particularly foot ulceration,  which is prevalent among individuals with type 2 diabetes, and diabetes- related erectile dysfunction. research indicates that quitting smoking leads to improved outcomes. These include enhanced limb perfusion, increased rates of amputation-free survival, and improved erectile function.

The management of diabetes should include specific counseling for the treatment of tobacco addiction,” concludes Davide Campagna, CoEHAR member. “This is the first review to provide evidence regarding smoking cessation’s impact on the course of diabetes-related complications. There should be consideration for structuring targeted and comprehensive interventions, based on both communication between healthcare professionals and patients with diabetes, and the implementation of public health initiatives aimed at reducing smoking incidence among those with diabetes.


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