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International consensus recommendations for smoking cessation in Type 2 diabetes

Prof. Roberta Sammut, from the Department of Nursing at the Faculty of Health Sciences has participated in the development of the world’s first international consensus recommendations dedicated specifically to smoking cessation in people with type 2 diabetes which is being published in the journal Diabetes Research and Clinical Practice. The aim is to make smoking cessation an essential component of diabetes care.

This recommendation was developed by the DiaSmokeFree working group, a group of 35 experts from 13 countries under the leadership of Prof. Riccardo Polosa from the Center of Excellence for the Acceleration of Harm Reduction (COEHAR) within the University of Catania.

Previous diabetes guidance has generally been limited to brief advice. Healthcare professionals have lacked comprehensive, diabetes-specific recommendations covering treatment selection, behavioural support, relapse prevention, metabolic monitoring and interactions between smoking and commonly prescribed medicines.

The document presents 34 evidence-informed recommendations for integrating smoking cessation into routine diabetes care. They include:

• Treating smoking cessation as an essential part of diabetes management.
• Offering varenicline as first-line pharmacotherapy where appropriate, with nicotine-replacement therapy or bupropion as alternatives.
• Combining pharmacotherapy with intensive behavioural support and proactive relapse management.
• Monitoring glycaemic control, body weight, blood pressure and drug–smoke interactions soon after cessation.
• Embedding cessation pathways within diabetes services through electronic prompts, automated referrals and multidisciplinary coordination.
• Expanding research into diabetes-specific interventions, emerging treatments, tobacco harm reduction, and digital support tools.

The recommendations approach quitting as a clinical process requiring sustained, individualised management.

“We are immensely proud of this pioneering achievement. For the first time, clinicians have comprehensive, actionable guidance designed specifically for a high-risk population that has been overlooked for too long” said Prof. Riccardo Polosa. “This turns a familiar instruction into a practical clinical pathway for helping patients with diabetes quit safely and successfully.”

"It has been a great honour to represent the University of Malta as a member of the DiaSmokeFree Working Group, contributing to this pioneering achievement’ stated Prof. Sammut. ‘The recommendations reflect scientific rigour, international collaboration and a shared commitment to improve patient outcomes. This is more than another consensus paper. It establishes a new standard for clinical care, research and professional education" she added.

Walicka, C. Russo, A. Ceriello, J. George, D. Campagna, A. Misra, G.R. Maria La Rosa, R. Sammut, R. Polosa, DiaSmokeFree Working Group, International consensus recommendations for smoking cessation in type 2 diabetes from the DiaSmokeFree Working group, Diabetes Research and Clinical Practice (2026), .