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IHS Diabetes Care & Outcomes Audit
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IHS Standards of Care for Patients
with Type 2 Diabetes
     September 2006    

Part 2: Supporting Statements 
  4.      Lifestyle Practice
  f.   Tobacco

 
 Assessment 

Every visit should include an assessment of tobacco use, status and history, and continued reassessment of tobacco status.  Providers should systematically document the history of tobacco use  for all adolescent and adult individuals with diabetes.

 

Counseling

All health care providers should advise individuals with diabetes not to initiate tobacco use (e.g., smoking or chew tobacco). This advice should be consistently repeated to prevent smoking and other tobacco use, particularly among children and adolescents with diabetes.

Tobacco users should complete cessation counseling as a routine component of diabetes care.  Providers should:

· Use a clear, strong, and personalized manner to urge every tobacco user to quit.
· Describe the added risks of tobacco use and diabetes.
· Ask every tobacco user with diabetes if he or she is willing to quit at the present time.  If the patient answers "no", he or she should receive a brief and motivational discussion regarding the need to stop using tobacco and the risks of continued use, as well as encouragement to quit and support when ready.  If the patient answers "yes", providers should assess the patient's treatment preferences and initiate either minimal, brief, or intensive cessation counseling and offer pharmacological supplements as appropriate.

 

Systems for delivery of tobacco cessation resources

Diabetes health care providers should consider training in the Public Health Service guidelines regarding tobacco cessation.    Providers should also use follow-up procedures designed to assess and promote quitting status for all diabetic tobacco users with diabetes.

 

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