title: Smoking cessation in adults with diabetes: a systematic review and meta-analysis of data from randomised controlled trials.
abstract: OBJECTIVE
  To evaluate the effects of more intensive smoking cessation interventions compared to less intensive interventions on smoking cessation in people with type 1 or type 2 diabetes.
  
  
  METHODS
  A systematic review and meta-analysis of randomised trials of smoking cessation interventions was conducted. Electronic searches were carried out on the following databases: MEDLINE, EMBASE, CINAHL and PsycINFO to September 2013. Searches were supplemented by review of trial registries and references from identified trials. Citations and full-text articles were screened by two reviewers. A random-effect Mantel-Haenszel model was used to pool data.
  
  
  METHODS
  Primary, secondary and tertiary care.
  
  
  METHODS
  Adults with type 1 or type 2 diabetes.
  
  
  METHODS
  Smoking cessation interventions or medication (more intensive interventions) compared to usual care, counselling or optional medication (less intensive interventions).
  
  
  METHODS
  Biochemically verified smoking cessation was the primary outcome. Secondary outcomes were adverse events and effects on glycaemic control. We also carried out a pooled analysis of self-reported smoking cessation outcomes.
  
  
  RESULTS
  We screened 1783 citations and reviewed seven articles reporting eight trials in 872 participants. All trials were of 6 months duration. Three trials included pharmacotherapy for smoking cessation. The risk ratio of biochemically verified smoking cessation was 1.32 (95% CI 0.23 to 7.43) for the more intensive interventions compared to less intensive interventions with significant heterogeneity (I(2)=76%). Only one trial reported measures of glycaemic control.
  
  
  CONCLUSIONS
  There is an absence of evidence of efficacy for more intensive smoking cessation interventions in people with diabetes. The more intensive strategies tested in trials to date include interventions used in the general population, adding in diabetes-specific education about increased risk. Future research should focus on multicomponent smoking cessation interventions carried out over a period of at least 1 year, and also assess impact on glycaemic control.
authors.affiliation: Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
authors.forename: Alexander
authors.initials: A
authors.lastname: Nagrebetsky
authors.forename: Rachel
authors.initials: R
authors.lastname: Brettell
authors.forename: Nia
authors.initials: N
authors.lastname: Roberts
authors.forename: Andrew
authors.initials: A
authors.lastname: Farmer
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D006801:Humans; D012907:Smoking / Q000188:drug therapy / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D014029:Tobacco Use Disorder / Q000150:complications / Q000188:drug therapy / Q000628:therapy
chemical_list: D001786:Blood Glucose
keywords: General Medicine (see Internal Medicine); Preventive Medicine