Semaglutide may aid tobacco cessation in patients with comorbid diabetes

1. In this retrospective study of patients with comorbid type 2 diabetes mellitus and tobacco use disorder (TUD), semaglutide use was associated with lower health care utilization relating to TUD compared with other antidiabetes medications.

2. Patients who received semaglutide were also less likely to receive prescriptions for smoking cessation medications compared to their counterparts.

Evidence Rating Level: 2 (Good)

Study Rundown: Tobacco use is a modifiable risk factor that contributes heavily to mortality from cardiopulmonary disease and cancer. Although some smoking cessation medications already exist, their real-world efficacy is limited. Semaglutide is a glucagon-like peptide-1 receptor agonist (GLP-1RA) approved for type 2 diabetes mellitus (T2DM) and obesity which has been associated with reduced risk of cannabis use disorder. Because tobacco use disorder (TUD) is closely linked with cannabis use disorder, it has been hypothesized that semaglutide may also be helpful in reducing tobacco usage among smokers. Thus, this target trial emulation study aimed to evaluate whether semaglutide was related to changes in TUD-related health care measures such as clinic visits, smoking cessation medication prescriptions, and counseling. Three different study populations were observed: all patients with T2DM and TUD, the subset with an additional obesity diagnosis, and the subset without an obesity diagnosis. Compared to other antidiabetes medications, semaglutide use was found to be associated with an overall decreased risk for TUD-related health care utilization, including medical encounters, prescriptions, and smoking cessation counseling. The generalizability of this study was limited by a lack of information on the severity of TUD, medication adherence rates, and variations in practice patterns across different sites. Nonetheless, these results demonstrated that semaglutide may be beneficial for smoking cessation.

Click to read the study in AIM

Relevant Reading: Association of semaglutide with reduced incidence and relapse of cannabis use disorder in real-world populations: a retrospective cohort study

In-Depth [retrospective cohort]: This target trial emulation study involved 222,942 new users of antidiabetes medications, of which 5967 were new users of semaglutide and 216,975 were new users of other antidiabetes medications. Patients were eligible if they had a diagnosis of T2DM and TUD, had health care utilization between December 2017 and March 2023, did not use antidiabetes medications in the past 12 months, and had at least one disease on the prescription guideline for semaglutide. Patients were excluded if they had a history of bariatric surgery, pancreatitis, type 1 diabetes, thyroid cancer, or gastroparesis. Semaglutide was associated with a reduced risk of medical encounters for TUD among those with a T2DM and TUD diagnosis compared with the other 7 antidiabetes medications. Specifically, the strongest comparison was with insulin (hazard ratio [HR], 0.68 [95% CI, 0.63 to 0.74]) while the weakest significant comparison was with other GLP-1RAs (HR, 0.88 [CI, 0.81 to 0.96]). Similarly, in patients who were not obese with T2DM and TUD, there was a lower risk of medical encounters for TUD associated with semaglutide use compared with the other diabetes medications (except for GLP-1RAs). These differences were generally greatest within the first 30 days of prescription, then diverged moderately until plateauing by day 180. Semaglutide use was also associated with a lower risk for being prescribed smoking cessation medication; the strongest association was against insulins (HR, 0.32 [CI, 0.28 to 0.38]) and the weakest was compared to other GLP-1RAs (HR, 0.62 [CI, 0.52 to 0.74]).

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.