Croyances et besoins des fumeurs diabétiques type 2 concernant l’arrêt du tabac


Ressource 1Download: Mémoire no 3910 Mme Clément.pdf (710.76 [Ko])
State: Public
Version: After imprimatur
Secondary document(s)
Download: Mémoire no 3910 Annexes Mme Clément.pdf (132.32 [Ko])
State: Public
Version: author
Serval ID
A Master's thesis.
Publication sub-type
Master (thesis) (master)
Croyances et besoins des fumeurs diabétiques type 2 concernant l’arrêt du tabac
Institution details
Université de Lausanne, Faculté de biologie et médecine
Publication state
Issued date
Number of pages
Diabetes and tobacco use are two major public health burdens. In Switzerland, 450’000 people live with diabetes, 90% of them have type 2 diabetes (1). The prevalence of type 2 diabetes is increasing, notably in developed countries, due to an increase in overweight and obesity (2). Smoking is the first cause of avoidable death worldwide (3). Nevertheless, it is estimated that more than 25% of the Swiss population uses tobacco (4) and, in a Swiss cohort of middle-aged people, 20,8% of people with diabetes smoked (5).
Among people with diabetes, smoking is associated with poor metabolic control (6-11) higher insulin needs (12, 13) and increased risk for hypoglycemia (14). Higher risks of retinopathy, nephropathy and peripheral neuropathy are also linked to tobacco use (15, 16). Worsened dyslipidemia is more likely to be found in diabetic smokers (17). Since diabetes and tobacco use act synergistically on morbidity and mortality, diabetic people who smoke are at increased risk of micro and macrovascular complications and premature death (18-20). For example, cigarette smoking raises the risk for coronary heart disease in diabetic patients (21) and it is estimated that up to 65% of cardiovascular deaths are caused by the interaction between diabetes and tobacco use (22). In addition, studies suggest that smokers increase their risk of developing type 2 diabetes by 44% (23). The results of a study, including men only, showed that, among other interventions reducing cardiovascular risk factors, smoking cessation is the best way to extend lifetime of diabetic people (24).
There are gender specificities regarding both diabetes and smoking. If women are less likely to suffer from type 2 diabetes than men (25), they have a stronger cardiovascular risk when they are (21, 22, 26). Moreover, results suggest that diabetic women are more likely to suffer from high blood pressure, obesity and dyslipidemia than men and that this cluster of cardiovascular risks add to their cardiovascular adverse profile (27). Regarding diabetic self care, women follow recommendations more closely and have a better glycaemic control than men (28). Reasons to smoke differ between men and women. Women tend more to use tobacco consumption to manage their stress and weight (29-32). Results suggest that weight gain is both a barrier to smoking cessation and a risk factor of failure of the cessation process among women (33-35). Women seem also to be less likely to quit smoking compared to men (36, 37).
It has been shown that diabetic smokers are less motivated to stop smoking than other smokers (38, 39). This could be notably explained by fear to gain weight (40, 41). Smokers with diabetes are also more likely to be suffering from depression, which is known to hinder efforts to stop smoking (42). Moreover, the information about the benefits of smoking cessation and available options for help may not be appropriate enough for diabetic smokers (43, 44). All these elements may contribute to the lower success rates in smoking cessation among smokers with diabetes (45).Results suggest that diabetic smokers are not fully aware of the risks of micro and macrovascular complications linked with tobacco use. Diabetic smokers are concerned about the impact of their weight, dietary adherence and the management of their diabetes (46) but they don’t consider smoking cessation as a priority (47). Indeed, after a diagnosis of diabetes, people will focus on weight loss, lower consumption of saturated fat and lower energy intake but the impact of a new diagnosis of diabetes on smoking cessation is borderline (48). On the contrary, a new diagnosis of cardiovascular disease will increase the rates of smoking cessation (48). Studies show that people with diabetes are less likely to be given cessation advice by health professionals (43). Moreover, there is limited evidence on the efficacy of smoking cessation interventions in people with diabetes (49).
Diabetic smokers may have specifics needs regarding tobacco cessation and may require a smoking cessation design that fits more to those needs to improve success rates. Furthermore, gender specificities should be better understood and integrated in smoking cessation interventions. Therefore, the aim of our study is to assess the attitudes, beliefs and needs of type 2 diabetic smokers regarding smoking cessation and understand potential gender differences. This information will help tailor a smoking cessation intervention adapted to gender and diabetes specificities.
Create date
06/09/2017 10:15
Last modification date
20/08/2019 12:30
Usage data