Certified diabetes educators help to expand smoking cessation services
SAN FRANCISCO — Most perioperative adults with diabetes made an unplanned attempt to quit smoking after enrolling in a smoking cessation program led by certified diabetes educators, with more than half reporting reduced smoking after attending the program, according to data presented at the American Diabetes Association Scientific Sessions.
Many health systems lack internal smoking cessation programs despite a critical need to personalize smoking cessation support for patients, Deborah Rosenberg, MS, RD, CDN, CDE, a certified diabetes educator at the Diabetes and Cardiovascular Alliance at Mount Sinai Hospital, and colleagues wrote in a poster. Although such programs are deemed important, they wrote, systems often lack the resources needed to create a program from scratch.
“We started this program by targeting perisurgical smokers, identified and referred to us by their surgeons or nurse practitioners,” Rosenberg told Endocrine Today. “We felt these patients would make for a good group of people to start with because there is potential for improved healing if they were to quit smoking before their surgeries.”
Rosenberg and colleagues analyzed data from 25 presurgical adults with diabetes who reported long-term smoking (78% at least 20 years), with most reporting at least one quit attempt (mean age, 62 years; 70% white; 57% attempting to quit between one and four times). Patients met with a certified diabetes educator smoking coach, trained by a Mount Sinai pulmonologist or tobacco treatment specialist, either in-person or via telehealth (57% in-person initial meetings; 71% of follow-ups via telehealth). Patients received customized behavioral or pharmacologic support in collaboration with the medical team and were offered the option to continue with the smoking cessation support program after surgery.
Within the cohort, 88% of enrolled patients made an unplanned quit attempt with a prescription medication or nicotine replacement therapy (47% used combination therapy), with 60% attempting to quit gradually and 32% quitting abruptly. After completing the program, 52% reported reduced smoking, 35% were smoke-free and 13% reported no change, according to researchers.
Rosenberg noted that part of the success of the program could be attributed to the cohort of patients.
“These were a motivated group of patients,” Rosenberg said in an interview. “They’re about to undergo surgery, so they are feeling nervous and anxious about their health.”
Rosenberg said patients were presented with multiple smoking cessation options, and ultimately chose the therapy they thought would be right for them.
“The other important point is we provided them with a lot of support — not just emotional support, but also strategies to change behavior,” Rosenberg said. “Also, we discussed medication options. We never pushed any particular medication. We went through the options and they were the driving force. Whether it was nicotine replacement therapy or Wellbutrin or Chantix (varenicline, Pfizer), the patient chose what they were comfortable with. We made it clear to them that this is an addiction, and there are medication options that can help.”
Rosenberg said following the successful pilot program, there are now plans to roll out the program to other physician practices in Mount Sinai Health System, as well as to Mount Sinai employees. – by Regina Schaffer
Schwartz A, et al. 864-P. Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.
Disclosures: Pfizer funded this study. The authors report no relevant financial disclosures.