Being a smoker with diabetes doubles the chances of complications or developing cardiovascular diseases. Yet, quitting for these persons isn’t easy, compounded by difficulties in managing a condition like diabetes. Behavioral therapies represent an area yet to be fully evaluated, with outcomes that could be a pivotal turning point for persons living with diabetes wanting to quit smoking. But which ones are most effective and what promising data have been obtained so far?
LINK: https://journals.sagepub.com/doi/10.1177/21501319241241470
Catania, April 30, 2024 – Diabetes is a condition affecting over 400 million people worldwide, leading to a radical change in the lifestyles of those afflicted. Unfortunately, among the modifiable risk factors significantly impacting the course of the condition, smoking poses a challenging obstacle: the components released by cigarette combustion not only represent a risk factor for pre-diabetes and diabetes mellitus, but it has also been demonstrated that the exacerbate diabetes-related complications.
But how can those who smoke and suffer from diabetes be helped today?
“Unfortunately, helping this specific category of patients isn’t simple,” explains Roberta Sammut, Associate Professor at the Faculty of Health Sciences, University of Malta, and lead author of the study. “Diabetes can trigger stress, anxiety, or depression, due to changes in the patients’ lifestyle. And smoking, for many, represents a way to cope with this condition.”
As with all smokers, behavioral therapies, possibly combined with substitute pharmacological therapy, could have positive effects. However, the scientific literature on this matter isn’t clear, leaving a wide field of investigation open.
“Considering the effectiveness of behavioral therapies, sometimes combined with pharmacological interventions, we wanted to assess the state-of-the-art research on these approaches among smokers livng with diabetes who want to quit and which interventions currently offer a greater chance of success. We thus evaluated the five most well-known types of intervention.”
The results were included in the review “Behavioural therapy for people with diabetes who smoke: a scoping review,” published in the Journal of Primary Care and Community Health: it is now clear that persons living with diabetes are not the subject of targeted treatments and that there is ample room for progress. It seems that more structured and intensive therapies could benefit these persons in bidding farewell to cigarette smoking, while little is still known about the possible benefits of combining behavioral therapies and nicotine replacement pharmacological therapies.
“The results confirm that we know little about how to effectively intervene among persons with diabetes who smoke, to break the complex mechanism regulating cigarette dependence, especially in the presence of other pathologies,” says Davide Campagna, Researcher in Internal Medicine at the Department of Clinical and Experimental Medicine of the University of Catania. “What we do know, however, is that this unexplored territory has the potential to greatly improve the living conditions of these persons, who often struggle against two enemies, the disease and smoking addiction“.
The review focused on analyzing the most important behavioral therapies for cessation, namely the 5A method, cognitive-behavioral therapy, motivational interviewing, contingency management, health coaching, and counseling. Out of a total of 1615 studies analyzed both in structure and results, it emerged that only 8 were within the scope of the investigation (3 for the 5A method, 4 for motivational interviewing, and 1 for counseling). A gap that demonstrates how a certain number of psychological interventions, particularly cognitive-behavioral interventions, which have proven effective in supporting smoking cessation in the population and in managing chronic diseases, have not yet been studied in relation to people living with diabetes.
In conclusion, to increase the likelihood of success persons living with diabetes who want to quit smoking, structured and intensive interventions are necessary, based on cutting-edge scientific evidence, resulting from methodologically relevant studies, and built around the needs of the individual and all those who assist them, including educational and training interventions for both informal caregivers and healthcare providers.
In conclusion, as declared by prof. Pasquale Caponnetto, researcher of clinical psychology at Section of Psychology Department of Educational Sciences at University of Catania: “To increase the likelihood of success persons living with diabetes who want to quit smoking, structured and intensive interventions are necessary, based on cutting-edge scientific evidence, resulting from methodologically relevant studies, and built around the needs of the individual and all those who assist them, including educational and training interventions for both informal caregivers and healthcare providers. And this study shows once again that beyond whatever tool is used to help people quit smoking, behavioral psychological support always increases the chances of quitting smoking“
Future research should also evaluate the combined approach of behavioral therapies and nicotine replacement therapies: the few studies included in this regard did not provide clear results, emphasizing the need to invest in this research area
