5.0.0.0 Smok­ing Ces­sa­tion: To­bac­co and e-‍Cigarettes

5.1.0.0 Overview

Re­sults from epi­demi­o­log­i­cal, case-‍con­trol, and co­hort stud­ies pro­vide con­vinc­ing ev­i­dence to sup­port the causal link be­tween cigarette smok­ing and health risks (163). Re­cent data show to­bac­co use is high­er among adults with chron­ic con­di­tions (164) as well as in ado­les­cents and young adults with di­a­betes (165). Smok­ers with di­a­betes (and peo­ple with di­a­betes ex­posed to sec­ond-‍hand smoke) have a height­ened risk of CVD, pre­ma­ture death, mi­crovas­cu­lar com­pli­ca­tions, and worse glycemic con­trol when com­pared with non­smok­ers (166,167). Smok­ing may have a role in the de­vel­opment of type 2 di­a­betes (168-171).

The rou­tine and thor­ough as­sess­ment of to­bac­co use is es­sen­tial to pre­vent smok­ing or en­cour­age ces­sa­tion. Nu­mer­ous large ran­dom­ized clin­i­cal tri­als have demon­strat­ed the efficacy and cost-‍ef­fec­tiveness of brief coun­sel­ing in smok­ing ces­sa­tion, in­clud­ing the use of tele­phone quit lines, in re­duc­ing to­bac­co use. Phar­ma­co­log­ic ther­a­py to as­sist with smok­ing ces­sa­tion in peo­ple with di­a­betes has been shown to be ef­fective (172), and for the pa­tient mo­ti­vat­ed to quit, the ad­di­tion of phar­ma­co­log­ic ther­a­py to coun­sel­ing is more ef­fective than ei­ther treat­ment alone (173). Spe­cial con­sid­erations should in­clude as­sess­ment of level of nico­tine de­pen­dence, which is as­so­ci­at­ed with difficulty in quit­ting and re­lapse (174). Al­though some pa­tients may gain weight in the pe­ri­od short­ly after smok­ing ces­sa­tion (175), re­cent re­search has demon­strat­ed that this weight gain does not di­min­ish the sub­stan­tial CVD benefit re­al­ized from smok­ing ces­sa­tion (176). One study in smok­ers with newly di­ag­nosed type 2 di­a­betes found that smok­ing ces­sa­tion was as­so­ci­at­ed with ame­lio­ra­tion of metabol­ic pa­ram­e­ters and re­duced blood pres­sure and al­bu­min­uria at 1 year (177).

In re­cent years e-‍cigarettes have gained pub­lic aware­ness and pop­u­lar­i­ty be­cause of per­cep­tions that e-‍cigarette use is less harm­ful than reg­u­lar cigarette smok­ing (178,179). Nonsmok­ers should be ad­vised not to use e-‍cigarettes (180,181). There are no rig­or­ous stud­ies that have demon­strat­ed that e-‍cigarettes are a health­i­er al­ter­na­tive to smok­ing or that e-‍cigarettes can fa­cil­i­tate smok­ing ces­sa­tion (182). On the con­trary, a re­cently pub­lished prag­mat­ic trial found that use of e-‍cigarettes for smok­ing ces­sa­tion was not more ef­fective than “usual care,” which in­clud­ed ac­cess to ed­u­ca­tional in­for­ma­tion on the health benefits of smok­ing ces­sa­tion, strate­gies to pro­mote ces­sa­tion, and ac­cess to a free text-‍mes­sag­ing ser­vice that pro­vided en­cour­agement, ad­vice, and tips to fa­cil­i­tate smok­ing ces­sa­tion (183). Sev­er­al or­ga­ni­za­tions have called for more re­search on the short-‍ and long-‍term safe­ty and health ef­fects of e-‍cigarettes (184-186).