Smoking, cessation, and the diabetes health care team

Cigarette smoking is a major risk factor in diabetes and contributes to the development of microvascular and macrovascular complications. Despite this, approximately one third of patients with diabetes smoke. Nicotine is physically and psychologically addictive, with multiple factors contributing to the initiation and continuation of the habit. Cessation is a process in which the smoker progresses through several stages of change, including precontemplation, contemplation, action, maintenance, and relapse. Knowledge of this process is needed for the diabetes health care team to effectively individualize smoking prevention and cessation strategies. This stepped care approach includes preventive, behavioral, and pharmacologic strategies as a component of routine diabetes education.