Why Smoking Cessation in Diabetes Care Is Still Treated Like an Optional Extra

Diabetes care today is highly structured. Clinicians monitor blood glucose, blood pressure, cholesterol, kidney function, and weight. Targets are set. Medications are adjusted. Follow-up is planned. But one major risk factor still sits at the edge of routine care: smoking.

A new commentary by Adebisi, Misra, and Polosa in the Journal of Diabetes argues that smoking cessation remains insufficiently integrated into diabetes management, despite the clear harms of smoking for people living with type 2 diabetes.

This argument matters because smoking is not a minor lifestyle issue in diabetes. It is a serious clinical problem. Smoking increases the risk of developing type 2 diabetes and worsens outcomes among those already diagnosed. For people living with diabetes, it adds further risk to an already vulnerable cardiovascular and metabolic profile. Yet in many clinical settings, smoking status is documented without being meaningfully acted on. It is noted, mentioned, and too often left there.

Smoking is not peripheral in diabetes care

That is the core message of the paper. Smoking should not be treated as separate from diabetes care. It should be treated as part of it. In practice, however, smoking cessation support often remains inconsistent, fragmented, or deferred. A patient may receive brief advice, but not structured support. A clinician may raise the issue, but without a clear pathway for follow-up. A risk factor may be recognised, but not managed with the same seriousness as HbA1c or blood pressure.

Smoking should not be treated as separate from diabetes care. It should be treated as part of it.

This is what the paper describes as cessation inertia. Not a lack of evidence, but a failure to translate what is already known into routine, accountable care. Diabetes services are designed to manage risk systematically, yet tobacco use is still too often handled as though it lies outside the main treatment pathway.

A gap between evidence and implementation

This gap is especially striking because the clinical case is already strong. Among people with diabetes, smoking is associated with higher risks of cardiovascular events, vascular complications, and premature mortality. Quitting is linked to better outcomes. The science is not the main problem here. The harder issue is implementation.

Why does this continue? The paper points to barriers at several levels. Patients may worry about weight gain after quitting or fear that cessation could disrupt glycaemic control. Some may also rely on smoking as a coping mechanism in the context of stress, chronic disease burden, or repeated failed quit attempts. Providers face their own challenges: limited consultation time, competing priorities, and insufficient cessation training. At the health-system level, referral pathways are often weak, reimbursement may be limited, and follow-up systems are poorly embedded.

What real integration would look like

The answer is not simply to tell patients to stop smoking more often. The paper argues for something more practical and more serious: smoking cessation should be operationalised within routine diabetes care. That means smoking status should be assessed regularly, discussed clearly, and followed by evidence-based support. Patients ready to quit should be offered treatment, not vague encouragement. Those not yet ready should still remain engaged rather than being written off until the next visit.

This is where the paper makes an important contribution. It frames smoking cessation not as an optional add-on, but as part of chronic disease management. That framing matters. When something is treated as peripheral, it is easier to postpone. When it is treated as core care, systems begin to organise around it.

Prevention must be treated as real treatment

There is also a wider lesson here. Health systems often say prevention matters, but what they truly prioritise is what gets measured, embedded, and followed up. Smoking cessation in diabetes care reveals that gap clearly. We already know tobacco is a major modifiable driver of harm in this population. The real question is whether care systems are willing to treat that fact with the seriousness it deserves.

The paper’s message is simple but important: if diabetes care is truly meant to reduce preventable complications and premature deaths, smoking cessation cannot remain at the margins. It has to move into the centre of care.

Yusuff Adebayo Adebisi

Pharmacist and epidemiologist advancing equity-driven, policy-relevant public health research. PhD Researcher at the University of Glasgow. Director of Research at Global Health Focus.

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