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Meta-Analysis
. 2025 Jun:224:112202.
doi: 10.1016/j.diabres.2025.112202. Epub 2025 Apr 26.

Pharmacological interventions for smoking cessation in Type 2 diabetes: A systematic review with meta-analysis and GRADE evaluation

Alison Martin  1 , Giusy Rita Maria La Rosa  2 , Hannah Rice  1 , Andrea Bertuzzi  1 , Michal Witkowski  1 , Erika Anastasi  3 , Giulio Geraci  4 , Riccardo Polosa  5 ; DiaSmokeFree Working Group
Collaborators, Affiliations
Free article
Meta-Analysis

Pharmacological interventions for smoking cessation in Type 2 diabetes: A systematic review with meta-analysis and GRADE evaluation

Alison Martin et al. Diabetes Res Clin Pract. 2025 Jun.
Free article

Abstract

Aims: To evaluate the efficacy and safety of pharmacological therapies for smoking cessation in individuals with Type 2 Diabetes Mellitus (T2DM) through a systematic review, meta-analysis, and GRADE evaluation.

Methods: PubMed and Scopus were searched on 7 June 2024 using relevant keywords. Randomized controlled trials and prospective cohort studies involving adult smokers with T2DM receiving pharmacological treatments for smoking cessation were included. Data were extracted independently by two reviewers. Random-effects meta-analyses were conducted, and the certainty of evidence was assessed using GRADE.

Results: Eighteen studies (19 publications) were included. Pharmacotherapy significantly increased continuous abstinence rates at 12 and 24 weeks (p < 0.001), with ORs of 4.17 (95 % CI: 2.71-6.42) and 3.80 (95 % CI: 2.52-5.72), respectively. At 52 weeks, varenicline was more effective than placebo (OR: 2.84, 95 % CI: 1.41-5.69, p = 0.003). Adverse events were more frequent with varenicline, but not significantly (OR: 1.40, 95 % CI: 0.98-1.98, p = 0.06).

Conclusions: Varenicline appears effective for smoking cessation in T2DM, with an acceptable tolerability profile. Bupropion and NRT show potential efficacy. However, most evidence comes from post hoc analyses in which diabetes was not a predefined variable, warranting cautious interpretation.

Keywords: Bupropion; GRADE; Meta-analysis; Nicotine replacement therapy; Smoking cessation; Systematic review; T2DM; Type 2 diabetes mellitus; Varenicline.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [Giusy Rita Maria La Rosa is a research fellow at University of Catania. She declares no conflict of interest. Alison Martin, Hannah Rice, Andrea Bertuzzi, Michal Witkowski, Erika Anastasi, Giulio Geraci, Agostino Di Ciaula, Tabinda Dugal, Syed Abbas Raza, Anoop Misra, Andre Pascal Kengne, Cristina Russo, Noel Somasundaram, Phuong Le Dinh, and Roberta Sammut declare no conflict of interest. Magdalena Walicka has received honoraria for lectures from Sanofi, AstraZeneca, Teva, Eli Lilly, and has received support for attending meetings from Sanofi, Novo Nordisk, and Berlin Chemie. Riccardo Polosa is full tenured professor of Internal Medicine at the University of Catania (Italy) and Medical Director of the Institute for Internal Medicine and Clinical Immunology at the same University. He has received grants from U-BIOPRED and AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), Foundation for a Global Action to End Smoking (formerly known as Foundation for Smoke-Free World), Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A/S, Sandoz, Merk Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, Forest Laboratories, Ministero dell Universita’ e della Ricerca (MUR) Bando PNRR 3277/2021 (CUP E63C22000900006) and 341/2022 (CUP E63C22002080006), funded by NextGenerationEU of the European Union (EU), and the ministerial grant PON REACT-EU 2021 GREEN- Bando 3411/2021 by Ministero dell Universita' e (MUR) – PNRR EU Community. He is founder of the Center for Tobacco Prevention and Treatment (CPCT) at the University of Catania and of the Center of Excellence for the Acceleration of Harm Reduction at the same university. He receives 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. He is also involved in a patent application for ECLAT Srl. He is a pro bono scientific advisor for Lega Italiana Anti Fumo (LIAF) and the International Network of Nicotine Consumers Organizations (INNCO); and he is 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].

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