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. 2024 Jun 18:15:1406860.
doi: 10.3389/fphar.2024.1406860. eCollection 2024.

A web-based scoping review assessing the influence of smoking and smoking cessation on antidiabetic drug meabolism: implications for medication efficacy

Carlo Maria Bellanca #  1   2 , Egle Augello #  1   2 , Giulia Di Benedetto #  1   2 , Chiara Burgaletto  1 , Anna Flavia Cantone  1 , Giuseppina Cantarella  1 , Renato Bernardini #  1   2 , Riccardo Polosa #  3   4   5 ; DiaSmokeFree Working Group
Collaborators, Affiliations

A web-based scoping review assessing the influence of smoking and smoking cessation on antidiabetic drug meabolism: implications for medication efficacy

Carlo Maria Bellanca et al. Front Pharmacol. .

Abstract

Currently 1.3 billion individuals globally engage in smoking, leading to significant morbidity and mortality, particularly among diabetic patients. There is urgent need for a better understanding of how smoking influences antidiabetic treatment efficacy. The review underscores the role of cigarette smoke, particularly polycyclic aromatic hydrocarbons (PAHs), in modulating the metabolic pathways of antidiabetic drugs, primarily through the induction of cytochrome P450 (CYP450) enzymes and uridine diphosphate (UDP)-glucuronosyltransferases (UGTs), thus impacting drug pharmacokinetics and therapeutic outcomes. Furthermore, the review addresses the relatively uncharted territory of how smoking cessation influences diabetes treatment, noting that cessation can lead to significant changes in drug metabolism, necessitating dosage adjustments. Special attention is given to the interaction between smoking cessation aids and antidiabetic medications, a critical area for patient safety and effective diabetes management. This scoping review aims to provide healthcare professionals with the knowledge to better support diabetic patients who smoke or are attempting to quit, ensuring tailored and effective treatment strategies. It also identifies gaps in current research, advocating for more studies to fill these voids, thereby enhancing patient care and treatment outcomes for this at-risk population.

Keywords: adverse drug reactions; cytochrome P450; diabetes mellitus; drug metabolism; drug-drug interactions; smoking cessation.

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Conflict of interest statement

RP has received the following EU and governmental competitive grants: U-BIOPRED, AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), Ministero dell’Università e della Ricerca (MUR) PNRR 3277/2021, PNRR 341/2022, and PNRR 411/2021 funded by NextGenerationEU of the European Commission. He has also received investigator-initiated grants from Foundation for a Smoke Free World, Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A/S, Sandoz, Merk Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, and Forest Laboratories. He is founder of the Center for Tobacco Prevention and Treatment (CPCT) and of the Center of Excellence for the Acceleration of Harm Reduction at Catania University. He has received consultancy fees from Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group. He receives textbooks royalties from Elsevier and EDRA. He is also Chair of the European Technical Committee for Standardization on “Requirements and test methods for emissions of electronic cigarettes” (CEN/TC 437; WG4) and scientific advisor of the non-profit Foundation RIDE2Med. RB is Associate Editor for Frontiers in Pharmacology. GC is Review Editor for Frontiers in Pharmacology. The remaining Authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic representation of number of tobacco smokers worldwide, which highlights the effect of smoking habit in accelerating type 2 diabetes-related consequences. Smoking worsens disease course altering glycometabolic parameters and long-term complications, namely diabetic retinopathy, cardiovascular diseases, and diabetic nephropathy. Created with BioRender.com; accessed on 12 March 2024.
FIGURE 2
FIGURE 2
Mechanism of induction of pioglitazone, canagliflozin, and dapagliflozin metabolism by cigarette smoke PAHs. Abbreviations: PAHs, polycyclic aromatic hydrocarbons; NADP+, nicotinamide adenine dinucleotide phosphate; NADPH, Nicotinamide Adenine Dinucleotide Phosphate Hydrogen. Created with BioRender.com; accessed on 15 March 2024.
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