Smoking cessation and harm reduction in type 2 diabetes: development of practical recommendations from the...

Smoking is a major modifiable risk factor in type 2 diabetes (T2D), yet cessation support remains inconsistently integrated into diabetes care. Clinicians face diabetes-specific barriers, including concerns about weight gain, glycemic variability, polypharmacy, limited consultation time, and lack of practical, tailored guidance. To address this gap, the Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, convened the DiaSmokeFree Working Group, an international multidisciplinary panel of 35 experts from 13 countries. The group used a structured, multi-stakeholder development process informed by AGREE principles and GRADE where feasible. The process included scope definition, targeted evidence identification, appraisal and synthesis, iterative drafting, internal review, consensus development, and planned external consultation. Evidence was drawn from existing systematic reviews, meta-analyses, major guidelines, landmark primary studies, and targeted searches in areas where T2D-specific evidence was limited. This paper describes the methodological framework underpinning the development of practical recommendations for healthcare professionals caring for people with T2D who smoke and wish to quit. The DiaSmokeFree initiative provides a transparent and reproducible pathway for developing internationally relevant, implementable recommendations that position smoking cessation as a core component of comprehensive T2D care.