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Remember that smoking increases risk of eye disease, nephropathy, and all types of macrovascular disease. The risk associated with smoking in someone with diabetes is even greater than in someone without diabetes with an increase in relative increase by 2-10X. For this reason, smoking reduction and/or cessation should be addressed at every clinic visit if the individual is still smoking.

While you may not be equipped to give in-depth and personalized dietary recommendations or DSME, on the other hand, you can very quickly be trained to address smoking cessation, which is arguably the most important part of counseling. A meta-analysis done in 1993 showed that smoking cessation has much greater survival benefit than most other interventions for diabetes. (Yudkin, JS. How can we best prolong life? Benefits of coronary risk factor reduction in non-diabetic and diabetic subjects. BMJ 1993; 306:1313.)

Click here for an algorithm for tobacco cessation.

To summarize, remember the 5 A’s: Ask, Advise, Assess, Assist, and Arrange. Once you have asked about the patient’s smoking status, advised quitting based on the clear evidence, and assessed the patient’s willingness to quit, you will have either a patient who is ready to quit within the next 30 days (in which case you can tell the patient you are glad to hear that and let your attending physician know) or not (in which case you can ask why not, reinforce the importance of doing so, and let the patient know you will make a note in the chart for the provider to ask the patient about it again at the next visit).