A new study published in JAMA Network has found that varenicline helps patients with type 2 diabetes to quit smoking.
Not only is cigarette smoking a major risk factor for cardiovascular disease, it is highly prevalent among patients with type 2 diabetes. Smoking worsens the effects of hyperglycaemia and other risk factors, accelerating vascular damage in patients with diabetes.
Compared with nonsmokers with diabetes, smokers have greater risks of mortality, coronary heart disease, stroke, and peripheral arterial disease. Quitting smoking has been associated with reduced mortality risk in patients with type 2 diabetes, as welling achieving better glycaemic control and lower cardiometabolic risk factors.
Smokers with type 2 diabetes are more reluctant quit than smokers without diabetes in part due to fear of weight gain. Weight gain needs to be controlled as part of any cessation intervention. The smoking cessation drug varenicline has been shown to help people without diabetes to quit, but considering the special behavioural and metabolic conditions of smokers with type 2 diabetes, its use and efficacy warranted investigation,
To this end, Cristina Russo, MD, and colleagues conducted a multicentre, double-blind, placebo-controlled randomised clinical trial with 300 participants. Patients with type 2 diabetes, average age 57.4 years who were smoking at least 10 cigarettes a day, and who intended to quit were randomised to either twice-daily varenicline 1mg or placebo treatment. Both groups received smoking cessation counselling. The trial consisted of a 12-week treatment phase followed by a 40-week follow-up, nontreatment phase. Intention-to-treat data analysis was performed from December 2020 to April 2021.
At weeks 9 to 24, continuous smoking abstinence was significantly higher for the varenicline than placebo group (24.0% vs 6.0%). At weeks 9 to 12 (31.3% vs 7.3%) and weeks 9 to 52 (18.7% vs 5.3%) were significantly higher for the varenicline vs placebo group. Adverse events in the varenicline group compared with the placebo group were nausea, insomnia, abnormal dreams, anxiety, and irritability. Serious adverse events were infrequent in both groups and not treatment-related.
The researchers concluded that using varenicline in a smoking cessation programme for people with type 2 diabetes is effective in achieving long-term abstinence without serious adverse events.
