Quality Standards for Diabetes Care Toolkit

Smoking cessation

Smoking kills an estimated 5000 people in New Zealand every year, and smoking-related diseases are a significant cost to the health sector. Most smokers want to quit, and there are simple effective interventions that can be routinely provided in both primary and secondary care (Ministry of Health 2014). There are consistent results from both cross-sectional and prospective studies showing enhanced risk for micro- and macrovascular disease, as well as premature mortality from the combination of smoking and diabetes (Ciccolo et al 2014). New Zealand guidelines state, ‘smoking cessation has major benefits and immediate health benefits for all smokers’ (New Zealand Guidelines Group 2012, p 25). Therefore, smoking cessation and other forms of treatment should be a routine component of diabetes care (American Diabetes Association 2014) and strongly and repeatedly recommended at any level of CVD risk.
All guidelines recommend that all people who smoke should be advised to quit and offered treatment to help them stop completely. A Cochrane review (Stead et al 2008) of nicotine replacement therapy (NRT) for smoking cessation concluded that: ‘All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50–70%, regardless of setting. The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT’ (Stead et al 2008, p 2).
In a more recent review of behavioural interventions to support smoking cessation, pharmacotherapy (both prescription and over-the-counter) and behavioural support were identified to aid cessation, and their combination is more effective than either alone (Ciccolo and Busch 2014).