On line ‘Diabetes and Smoking’ Survey: results and com¬ments

Abstract

Cigarette smoking increases the risk of micro and macrovascular complications among subjects with diabetes. Smoking is also associated with both beta-cell function deterioration and insulin resistance. In the modern approach to the management of the global cardiovascular risk of the diabetic patient, cigarette smoking needs the same attention as other major factors (glycaemia, blood pressure and cholesterol). The prevalence of smokers, according to the AMD 2020 Annals, is 16,9% among type 2 diabetic patients and 25,9% among type 1 diabetic patients. These rather high percentages, in line with the overall population data, suggest the need of a greater and more effective engagement by diabetes team to discouraging smoking. The ‘Diabetes and Smoking’ Survey was designed by the ‘Diabetes and Addictions’ AMD-SID Lazio Working Group in order to analyze the perception that diabetologists have of smoking, to explore their specific knowledge of the smoking treatment, to highlight the interventions adopted to discourage smoking and to identify critical issues in clinical practice. The Survey has shown, first of all, the need to sensitize diabetologists to the topic of smoking: not everyone believes that smoking is addictive and not everyone adequately investigates it in anamnesis and includes it in medical records. The Survey also identified specific knowledge required on treatments for cigarette smoking addiction: diabetologists know little about drugs for smoking treatment, have false beliefs about new devices for smoking (electronic cigarettes and heated tobacco) and are little or not in contact with Anti-Smoking Centers. Currently, the intervention strategy preferred by diabetologists is to inform patients about smoking related damage, an approach of proven low efficacy (knowledge is not enough to change behaviors). Psychologists are rarely part of the diabetes Team, but even when this happens, they are not involved in the smoking addiction treatment. Finally, the Survey highlighted that the main obstacle perceived by diabetologists in the fight against smoking is the lack of a structured care process. The objective of the ‘Diabetes and Addictions’ Working Group is filling the gap between overall diabetes care (control and improvement of any micro and macrovascular risk factor) and smoking addiction treatment. KEY WORDS addiction; cessation; minimal advice; antismoking centers; structured care process.