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Prospective, Cluster-Randomized Trial to Implement the Ottawa Model for Smoking Cessation in Diabetes Education Programs in Ontario, Canada

2017; American Diabetes Association; Volume: 41; Issue: 3 Linguagem: Inglês

10.2337/dc17-1809

1935-5548

Robert D. Reid, Janine Malcolm, Evyanne Wooding, Amy Geertsma, Debbie Aitken, D. Arbeau, Chris M. Blanchard, Jo-Anne Gagnier, Anil Kumar Gupta, Kerri‐Anne Mullen, Paul Oh, Sophia Papadakis, Heather Tulloch, Allana G. LeBlanc, George A. Wells, Andrew Pipe,

Diabetes Management and Education

OBJECTIVE To test whether a practice-level intervention to promote the systematic identification, treatment, and follow-up of smokers (the Ottawa Model for Smoking Cessation [OMSC]) would improve long-term abstinence rates among smoker-patients with type 2 diabetes or prediabetes receiving care from diabetes education programs in Ontario, Canada. RESEARCH DESIGN AND METHODS The Tobacco Intervention in Diabetes Education study was a matched-pair, cluster-randomized clinical trial. Within each pair, sites were randomly allocated to either an OMSC intervention (n = 7) or a wait-list control (WLC) condition (n = 7). Diabetes education programs in the OMSC group introduced standardized processes to identify smokers and routinely provided smoking cessation interventions and follow-up. Smokers in the OMSC group received counseling, a discount card to partially cover the cost of smoking cessation medication, and follow-up telephone calls over a 6-month period. Diabetes education programs in the WLC condition were offered the OMSC intervention after a 1-year waiting period. Smokers in the WLC group received usual care for smoking cessation from their diabetes educator. The primary end point was carbon monoxide (CO)–confirmed 7-day point prevalence abstinence from smoking at 6-month follow-up. RESULTS A total of 313 smokers (OMSC group n = 199, WLC group n = 114) with diabetes or prediabetes were enrolled. The CO-confirmed abstinence rate at 6 months was 11.1% in the OMSC group versus 2.6% in the WLC group (odds ratio 3.73 [95% CI 1.20, 11.58]; P = 0.02). CONCLUSIONS Implementation of the OMSC in diabetes education programs resulted in clinically and statistically significant improvements in long-term abstinence among smokers with diabetes or prediabetes.