Last Updated: May 1, 2020

Author: Diabetes Program, Vermont Department of Health

Vermonters living with diabetes are seen by many providers, including primary care providers, certified diabetes educators (CDEs), and endocrinologists. Tobacco cessation is critical for people with diabetes who smoke because tobacco use escalates diabetes-related complications such as lower extremity amputations. Vermont Department of Health (VDH) staff develop and distribute resources to assist all providers with tools to reduce diabetes complications. Outreach to CDEs occurs via e-list updates and live meetings. CDEs, in turn, reach out to their patients during individual and group appointments and “classes", support groups, and workshops. As the trend line indicates, the number of 802Quits referrals changes quite dramatically each quarter. The reasons for this are unknown. In 2012 and 2013, referrals were as high as 37 and low as 22 per quarter, but never dipping below 20. Because the number of referrals remained at or above 20, the VDH Diabetes Program Administrator decided to increase the target in the fall of 2014 to 25. Q3 in 2015 was the lowest dip in referrals (17) since Q1 in 2013. The number dipped again to 17 again in Q4 2016 and again to 23 in Q3 2017 but has most often remained above target.

• National Jewish Health, Vermont's Quit by Phone and Online tobacco cessation vendor provides monthly data to VDH tobacco cessation staff about Vermonters with diabetes who register for the service. The intake performed at registration determines whether or not the smoker has diabetes.
• Tobacco cessation staff collaborates with Diabetes Prevention and Control staff to develop resources targeting people with diabetes who smoke.
• External partners have included the Vermont Blueprint for Health and the certified diabetes educators (CDEs) who belong to the Vermont Association of Diabetes Educators.
• In the past VDH Diabetes staff has reached out to the CDEs to promote use of the quit by phone services, during routine visits for self-management support. Reminders to promote quit by phone services are needed periodically.

Periodic communications to CDEs to encourage referrals to 802Quits' Quit by Phone services continue. This is the one component of 802Quits that VDH staff can track reliably. Online Quit programs do not have as reliable a method for identifying people with diabetes, and the Quit in person programs have the least reliability in tracking people with diabetes. However, VDH staff should encourage smokers with diabetes to choose among the three programs for cessation described at the website of 802Quits. An interesting observation is that 802Quits callers with diabetes have a higher completion rate (4 or more calls) than those who do not have diabetes. To date there have not been focused, specific strategies tailored to address primary care staff about the connections between tobacco use, diabetes risk, and diabetes complications. This effort commenced with collaboration among chronic disease programs in the fourth quarter of 2015. VDH can strategically augment individual program initiatives through collaborative efforts across chronic disease programs in VDH's Division of Health Promotion and Disease Prevention. A fall Tips television campaign ran from September 29, 2014 through November 16, 2014 that featured “Bill" a smoker living with diabetes who needed lower extremity amputation. This video was added to the Diabetes Program page in August 2015. Diabetes staff plans ongoing collaborative efforts with Tobacco staff for promoting tobacco cessation and for data retrieval available from National Jewish Health. Tobacco cessation programs have been added to the collaborative microsite overseen by the Health Department, The Blueprint for Health, and the University of Vermont Medical Center Community Health Improvement Program: Helping Yourself to Health at http://myhealthyvt.org/. In the Fall of 2016 a tobacco cessation specialist addressed CDEs at their annual meeting regarding the harmful effects of smoking on diabetes management.

In 2017, VDH Staff members will:

1. Examine consumer education resources that address diabetes and tobacco focusing on the effects of smoking on diabetes and health.

2. Plan with communications staff for FY17 marketing that reaches primary care staff and CHTs re tobacco cessation services to incorporate diabetes.

3. Check to see if collecting data regarding other quit methods is possible using current and future resources.