As a health worker or practitioner, you will be aware of the increased rate and risk of developing type 2 diabetes for Aboriginal and Torres Strait Islander people. The incidence is four times higher compared to that of other Australians. You may also be aware that the incidence of smoking is also significantly higher for First Nations peoples; approximately double that of other Australians.

So, what is it about diabetes and smoking that we should be concerned about, and what can we do to best support and help our clients quit?

Increased risk of type 2 diabetes

Research indicates that either being a smoker or being exposed to second-hand smoke can significantly increase the risk of developing type 2 diabetes. While the exact mechanism isn’t fully understood, the possible associations are that smoking increases central adiposity and insulin resistance, which in turn may alter insulin secretion and increase inflammation and oxidative stress.

Due to this increased risk that smoking brings, starting the discussion and assisting a person to quit should be seen as a high priority. In addition to smoking, other type 2 diabetes risk factors should ideally also be simultaneously addressed. This includes health behaviours such as healthy eating, regular physical activity, stress reduction, as well as the management of health markers such as blood pressure and cholesterol.

The impact of smoking on diabetes

We know that both diabetes and smoking can have significant impacts on a number of organs in the body. Diabetes itself is associated with long term complications that effect both the macro-vascular and micro vascular systems. Macro-vascular complications include the increased risk of cardiovascular and peripheral vascular disease. Micro-vascular complications on the other hand include retinopathy, nephropathy and peripheral neuropathy.

If someone has diabetes but also smokes the risk of these complications soar. This increase occurs due to both smoking and diabetes, contributing to the weakening, clogging, narrowing and hardening of blood vessels.

In addition to these complications, smoking will also contribute to other autonomic complications. This includes sexual health issues such as erectile dysfunction in men, gastroparesis along with changes to bladder and bowel function.

Other health impacts of smoking

• Smoking is linked to a number of different cancers (lung, throat, neck, mouth, stomach, bowel, bladder & cervical).
• For both men and woman smoking can affect fertility.
• In pregnancy, outcomes for both mother and baby are compromised.
• The nicotine from smoking causes staining, weakening and damage of skin, nails and teeth.
• Smoking lowers your immune function with people more at risk of respiratory illnesses.

What can you do to support your clients?

✓ Screening: This is an important step in supporting your clients living with diabetes. Checking if they are having their regular eye checks, foot screens or their medication reviewed lately is essential to ensure the risk of diabetes related complications is reduced.

✓ Regular pathology: Are they having regular blood and urine checks? Is their blood pressure, cholesterol and HbA1c being regularly monitored and controlled?

The Annual Cycle of Care is a great tool for both health professionals and the person living with diabetes to be aware of what checks need to be done. The NDSS has also recently created Information Prescriptions which can be used by GP or health professionals to help explain health factors (such as blood pressure, cholesterol, HbA1c etc) with their clients.

✓ Support: If your client is a smoker, how can you support a person to quit? Start the conversation!

–           Are they aware of the impact of smoking on both their diabetes and their overall health?

–           Have they tried to quit before? What worked, what caused a person to recommence?

–           What barriers do they have to quitting – how can you help with those?

–           What’s available to help a person quit – medications, gums, patches, the Quitline! Did you know, the Quitline also offers an indigenous specific service for those living in NSW & ACT, the Aboriginal Quitline.

Being able to clearly highlight the benefits of quitting (health, fitness and financial), is a great starting point. Even being able to share that there are health benefits to quitting smoking within just 20 minutes of their last cigarette can be very powerful.

In summary

Stopping smoking is one of the most effective health gains that can be made. It can achieve the biggest positive health outcomes compared with other lifestyle interventions. Quitting smoking however, is difficult and may take several attempts and years to achieve. For this reason, it is important that you as the health professional, continue to have the conversation and offer support and advice to all your clients who smoke on how they can achieve smoking cessation.