Diabetes and Tobacco

Every year, World No Tobacco Day highlights the harmful effects of tobacco use and the importance of supporting people to quit smoking. For people living with diabetes (PwD), avoiding tobacco is especially important. Smoking increases the risk of developing type 2 diabetes (T2D) and can make diabetes management more difficult. It also increases the risk of serious diabetes-related complications including cardiovascular diseases, chronic kidney disease, retinopathy, neuropathy amongst others. 

The good news is that quitting smoking at any point can improve health outcomes. 

 

The link between smoking and diabetes 

Smoking affects how the body uses insulin, making it harder to regulate blood glucose levels. Nicotine has been shown to increase insulin resistance, while other chemicals in tobacco smoke contribute to inflammation and oxidative stress, further impairing glucose metabolism and damaging blood vessels. 

Research shows that smokers are significantly more likely to develop T2D compared to non-smokers. For PwD, smoking can make blood glucose management more challenging and increase the risk of both short-term and long-term complications. 

 

Smoking and diabetes-related complications 

Cardiovascular disease 

Smoking is a major contributor to blood vessel damage and can significantly increase the risk of heart attack and stroke in PwD. Research shows that smokers with diabetes are around 50% more likely to experience cardiovascular events, including coronary heart disease and stroke, than non-smokers with diabetes. 

Several studies have found that people living with T2D who stop smoking reduce their risk of heart attack and stroke compared with those who continue smoking. 

 

Kidney disease 

Smoking can accelerate kidney damage in PwD through several mechanisms. Nicotine and other toxic substances in tobacco smoke contribute to inflammation, oxidative stress and damage to blood vessels, all of which can impair kidney function over time. Research has shown that smokers living with T2D are more than twice as likely to develop albuminuria compared to non-smokers. Smoking is also associated with a faster progression of diabetic kidney disease and a greater risk of chronic kidney disease. 

 

Eye complications 

Protecting eye health is an important part of diabetes care. Find out more about diabetic retinopathy. 

Smoking may contribute to damage in the small blood vessels of the retina by reducing blood flow and increasing oxidative stress. 

 

Nerve damage 

Nerve damage can be worsened by impaired circulation and increased inflammation. PwD who smoke may be at greater risk of neuropathy symptoms such as pain, numbness and tingling in the feet and hands. 

 

Foot complications 

Smoking contributes to poor circulation and peripheral arterial disease, which can increase the risk of diabetic foot ulcers, infections and amputations. 

For PwD, maintaining healthy circulation is essential to preventing foot complications. Quitting smoking can improve blood flow and support healing. 

 

Benefits of quitting smoking 

Quitting tobacco use has immediate and long-term benefits for PwD. 

Benefits may include: 

  • Improved blood circulation 
  • Better blood pressure control 
  • Reduced inflammation 
  • Lower risk of heart disease and stroke 
  • Slower progression of kidney disease 
  • Improved overall diabetes management 

 

Strengthening tobacco control and cessation policies 

To effectively reduce smoking rates and protect PwD, stronger policy action is needed. Policymakers should prioritise comprehensive tobacco control strategies, including stricter regulation of tobacco marketing and expanded smoke-free environments. 

At the same time, access to evidence-based smoking cessation services should be strengthened and fully integrated into healthcare systems. This includes ensuring the availability of nicotine replacement therapy and cessation medications, as well as behavioural support, as part of routine diabetes care. 

Targeted public health campaigns are also essential to raise awareness of the specific risks that smoking poses for PwD, particularly in relation to cardiovascular, renal and other complications. Finally, healthcare systems should be supported to systematically identify smokers and provide structured cessation support. 

 

A healthier future starts today 

Tobacco and diabetes are a dangerous combination, but quitting smoking can significantly improve health outcomes and reduce the risk of serious complications. 

On World No Tobacco Day, we encourage PwD, healthcare professionals and policymakers to work together to support tobacco cessation and create healthier environments for everyone. 

 

Resources  

These resources provide practical tools to design, implement and evaluate comprehensive tobacco control strategies, in line with global commitments to reduce tobacco use and its related health burden. 

  • World Health Organization – Framework Convention on Tobacco Control (WHO FCTC)
    https://fctc.who.int/  
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