New Delhi [India], November 14 (ANI): With an estimated 101 million Indians living with diabetes and another 136 million with prediabetes, experts are calling for helping people quit tobacco to become a more decisive component of diabetes prevention and management. 

Experts emphasise that telling people tobacco is harmful is not enough, as nicotine addiction makes quitting difficult and relapse remains common. Sustained support to quit tobacco, they say, must be treated as a healthcare priority rather than a one-time recommendation.

A 2026 analysis of Global Burden of Disease (GBD) 2023 estimates found that tobacco use was attributable to 47,240 diabetes deaths and 1.77 million disability-adjusted life years (DALYs) in India in 2023. 

Published in BMJ Open, the analysis estimated that tobacco accounted for 7.9 per cent of diabetes deaths in the country, highlighting its contribution to the metabolic disease burden. These are population-level attributable estimates derived through modelling, rather than directly recorded deaths.

The ICMR-INDIAB study estimated India's diabetes burden at 101 million people, with another 136 million living with prediabetes. 

Smoking is associated with increased insulin resistance and impaired glucose regulation, and can increase the risk of developing Type 2 diabetes. For people already living with diabetes, tobacco exposure further compounds cardiovascular and vascular risks, making helping people quit tobacco relevant both to prevention and disease management.

"Tobacco is often discussed in the context of cancer, heart disease and stroke, but its relationship with diabetes deserves equal attention. Smoking increases insulin resistance and can interfere with the body's ability to regulate blood glucose, increasing the risk of developing Type 2 diabetes. For people already living with diabetes, tobacco use further compounds cardiovascular and vascular risks. Helping people quit tobacco must therefore become an integral part of diabetes prevention and management. For individuals who struggle to quit despite repeated attempts, healthcare professionals must also be equipped to explore scientifically evaluated alternatives and risk-reduction approaches, alongside continued quitting support, to help protect metabolic health and improve long-term outcomes," said Dr Saptarshi Bhattacharya, Secretary, Endocrine Society of Delhi, Senior Consultant, Indraprastha Apollo Hospitals, New Delhi

Experts caution that the persistent gap between awareness of tobacco-related risks and successful quitting reflects the need for more sustained support. Many tobacco users make repeated attempts to quit, while others return to smoking after initially stopping. Brief advice alone may not be sufficient; access to behavioural counselling, evidence-based medicines to support quitting and follow-up can help people sustain abstinence and return for support after a relapse.

"India's diabetes prevention efforts cannot afford to overlook tobacco use. We have spent years communicating that smoking is harmful and quitting is best, yet a significant number of tobacco users continue to struggle with nicotine addiction or return to smoking after quitting. The challenge is evident in our own data: only 38.5% of smokers attempted to quit in the preceding year, and research indicates that just 14.2% of ever-daily smokers had successfully quit. Moreover, nearly half of cigarette and bidi smokers who attempted to quit were unable to sustain abstinence beyond a month. As a country advancing rapidly in science and healthcare, we must approach this challenge more pragmatically. Countries such as Japan, the USA and the UK have adopted different regulatory approaches to evaluating and making science- and technology-based alternatives available to adult smokers. These experiences offer important lessons for India as we examine the evolving global scientific evidence. While quitting tobacco completely remains the best outcome, we should also consider how appropriately regulated, evidence-based alternatives could help adults who are unable to quit move away from combustible cigarettes, reduce their exposure to harmful substances and protect their long-term health. Our response must move beyond awareness to sustained quitting support, scientific evaluation and a more comprehensive approach to addressing the tobacco challenge," said Dr Manoj Kr Rawat, Senior Consultant, Internal Medicine & Diabetologist, Manipal Hospital, Dwarka

Emerging research also highlights the importance of supporting metabolic health after quitting smoking. Some people experience weight gain after quitting, which may temporarily influence their diabetes risk. Experts stress that this should not be interpreted as a reason to continue smoking. Instead, weight management, physical activity and appropriate blood glucose monitoring should accompany quitting support, helping individuals sustain abstinence while addressing metabolic concerns.

On World Diabetes Day, experts call for tobacco use to be routinely addressed as part of diabetes prevention and care, with stronger support for people seeking to quit. 

Moving beyond awareness to sustained quitting support, alongside pragmatic and science-led approaches to addressing tobacco-related risks, is essential to reducing the burden of tobacco-related diseases and strengthening India's response to diabetes. (ANI)