International consensus recommendations for smoking cessation in type 2 diabetes from the DiaSmokeFree Working group.

AIMS: To provide evidence-based recommendations for integrating smoking cessation into the prevention and management of type 2 diabetes (T2D). METHODS: A multidisciplinary panel of 35 experts from 13 countries developed recommendations through a structured, multi-stakeholder consensus process, grading evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach where feasible, and reported findings in line with the Appraisal of Guidelines for Research and Evaluation (AGREE) framework. RESULTS: Smoking remains common among people with T2D and is associated with increased cardiovascular, stroke, and macrovascular risk. Smoking cessation substantially reduces this risk. Evidence on pharmacological treatment in T2D is limited; varenicline is the only medication that can be strongly recommended. Intensive, individualized interventions combining pharmacotherapy, behavioral support, and relapse management are more effective than brief interventions, and drug-smoke interactions may require dose adjustments (e.g., for drugs affected by CYP1A2, UGT enzymes, or renal transporters). CONCLUSIONS: Adults with T2D who smoke require integrated, high-intensity cessation support throughout the quitting process to reduce diabetes-related complications and improve long-term health outcomes.