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Diabetes and Smoking Cessation: a Gender Oriented Intervention Trial

Applicant Clair Carole
Number 154732
Funding scheme Ambizione
Research institution Policlinique Médicale Universitaire Université de Lausanne
Institution of higher education University of Lausanne - LA
Main discipline Clinical Endocrinology
Start/End 01.01.2015 - 31.12.2018
Approved amount 566'682.00
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All Disciplines (2)

Discipline
Clinical Endocrinology
Addictive Diseases

Keywords (5)

Diabetes; Gender; Intervention trial; Smoking; Metabolism

Lay Summary (French)

Lead
Le diabète et le tabagisme sont tous deux des enjeux majeurs de santé publique. Lorsqu’une personne diabétique fume, ses risques de complications au niveau des organes (reins, yeux, cœur) sont considérablement augmentés ainsi que son risque de mortalité. Pourtant plus de 20% des diabétiques fument encore la cigarette en Suisse.
Lay summary

Contenu et objectif du travail de recherche

Cette étude a pour premier but d’évaluer les croyances et besoins des fumeurs diabétiques et des professionnels de santé concernant l’arrêt de la cigarette. Nous prévoyons ensuite d’adapter aux besoins spécifiques des fumeurs ainsi qu’aux spécificités liées au genre une intervention pour aider les fumeurs à arrêter de fumer. Nous allons tester cette intervention dans une étude randomisée et contrôlée incluant 520 fumeurs diabétiques. Nous compareront les taux d’arrêt entre le groupe ayant eu l’intervention et le groupe contrôle ayant reçu un conseil minimal. Nous évaluerons également l’impact de l’arrêt de la cigarette sur les variables anthropométriques (poids, index de masse corporelle, périmètre abdominal) ainsi que sur le contrôle du diabète (taux de sucre dans le sang, besoin en médicaments antidiabétiques). Nous explorerons ensuite si l’efficacité de l’intervention et si les effets métaboliques de l’arrêt de la cigarette diffèrent entre les hommes et les femmes.

Contexte scientifique et social du projet

L’efficacité des interventions d’aide à  l’arrêt du tabac a été bien démontrée dans une population saine, toutefois peu d’études ont évalué l’efficacité des ces interventions chez des patients diabétiques. De plus il existe des disparités en santé liées au genre que ce soit dans les motivations et ou difficultés d’arrêt du tabagisme mais également au niveau des conséquences métaboliques de l’arrêt. Il est dès lors important de comprendre et tenir compte de ces différences.  

Direct link to Lay Summary Last update: 24.08.2015

Responsible applicant and co-applicants

Employees

Publications

Publication
Modeling empathy as synchrony in clinician and patient vocally encoded emotional arousal: A failure to replicate.
GaumeJacques, HallgrenKA, ClairCarole, Schmid MastM, CarrardValérie, AtkinsDC (2019), Modeling empathy as synchrony in clinician and patient vocally encoded emotional arousal: A failure to replicate., in J Couns Psychol, 1-9.
Biais de genre chez les généralistes.
ClairCarole (2018), Biais de genre chez les généralistes., in Revue Médicale Suisse, 14(630), 2228-2228.
Snus and Snuff Use in Switzerland Among Young Men: Are There Beneficial Effects on Smoking?
Gmel Gerhard, Clair Carole, Rougemont-Bücking Ansgar, Grazioli Véronique S, Daeppen Jean-Bernard, Mohler-Kuo Meichun, Studer Joseph (2018), Snus and Snuff Use in Switzerland Among Young Men: Are There Beneficial Effects on Smoking?, in Nicotine & Tobacco Research, 20(11), 1301-1309.
Medicine and gender : which challenges for clinical practice ?
ClairCarole, CornuzJacques, BartPA, SchwarzJoelle (2018), Medicine and gender : which challenges for clinical practice ?, in Revue Médicale Suisse, 14(625), 1951-1954.
A 10-year observational study on the trends and determinants of smoking status
Samim Daryoush, Méan Marie, Clair Carole, Marques-Vidal Pedro (2018), A 10-year observational study on the trends and determinants of smoking status, in PLOS ONE, 13(7), e0200010-e0200010.
Weight gain after smoking cessation: more data to refute concerns
Rigotti Nancy A, Clair Carole (2018), Weight gain after smoking cessation: more data to refute concerns, in European Heart Journal, 39(17), 1532-1534.
Sexe, genre et chirurgie
ClairCarole (2018), Sexe, genre et chirurgie, in Revue Médicale Suisse, 14, 588-589.
Sex/gender bias in the management of chest pain in ambulatory care
Clerc LiaudatChristelle, VaucherPaul, De FrancescoTomaso, Jaunin-StalderNicole, HerzigLilly, VerdonFrançois, FavratBernard, LocatelliIsabella, ClairCarole (2018), Sex/gender bias in the management of chest pain in ambulatory care, in Womens Health, 14, 1-9.
Cigarette électronique (vaporette) et « nouvelles » cigarettes : que faut-il dire aux patients ?
CornuzJacques, ClairCarole (2017), Cigarette électronique (vaporette) et « nouvelles » cigarettes : que faut-il dire aux patients ?, in Revue Médicale Suisse, 13(566), 1179-1179.
Smoking, vaping and cardiovascular risk : an update
DalkouS, ClairCarole (2017), Smoking, vaping and cardiovascular risk : an update, in Revue Médicale Suisse, 13(566), 1186-1190.
The Scientific Commission of the Swiss Cigarette Manufacturers Association : a historical overview
OlivierJacques, CornuzJacques, ClairCarole (2017), The Scientific Commission of the Swiss Cigarette Manufacturers Association : a historical overview, in Revue Médicale Suisse, 138(566), 1198-1205.
Clinical decision making : from theory to practice… and backward
De AlencastroLionel, ClairCarole, LocatelliIsabella, EbellMH, SennNicolas (2017), Clinical decision making : from theory to practice… and backward, in Revue Médicale Suisse, 13(562), 986-989.
Smoking bans: let's be comprehensive and not compromise health!
ClairCarole (2017), Smoking bans: let's be comprehensive and not compromise health!, in Swiss Medical Weekly, 147(w14404), 1-2.
Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial
Desgraz Benoît, Collet Tinh-Hai, Rodondi Nicolas, Cornuz Jacques, Clair Carole (2017), Comparison of self-perceived cardiovascular disease risk among smokers with Framingham and PROCAM scores: a cross-sectional analysis of baseline data from a randomised controlled trial, in BMJ Open, 7(1), e012063-e012063.
Association between smoking and recurrence of venous thromboembolism and bleeding in elderly patients with past acute venous thromboembolism.
CarruzzoPhilippe, MéanMarie, LimacherAndrea, AujeskyDrahomir, CornuzJacques, ClairCarole (2016), Association between smoking and recurrence of venous thromboembolism and bleeding in elderly patients with past acute venous thromboembolism., in Thrombosis Research, 138, 74-79.
Smoking cessation and the incidence of pre-diabetes and type 2 diabetes: a cohort study
Le Boudec Joana, Marques-Vidal Pedro, Cornuz Jacques, Clair Carole (2016), Smoking cessation and the incidence of pre-diabetes and type 2 diabetes: a cohort study, in Journal of Diabetes and its Complications, 30(1), 43-48.
Tobacco and diabetes: another good reason to not smoke (or to stop)
ClairCarole (2015), Tobacco and diabetes: another good reason to not smoke (or to stop), in Revue Médicale Suisse, 11(493), 2088-2088.
Gender and disparities: the example of tobacco smoking
Clair C de Kleijn MJ Jaunin-Stalder N Cornuz J. (2015), Gender and disparities: the example of tobacco smoking, in Revue Médicale Suisse, 11(478), 1298-12303.

Collaboration

Group / person Country
Types of collaboration
PD, Dr MED Anne Zanchi, EDM, CHUV Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Dr. Nancy Rigotti / Harvard University, Boston, USA United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Gilbert Greub/ Institut de microbiologie/CHUV Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof. Jardena Puder, Endocrinologie diabétologie métabolisme, CHUV Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Dr. Andrea Weinberger / Yale University, New Heaven, USA United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
Dr Elizabeth Zemp /Université de Bâle, Suisse Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Prof Louise Pilote, McGill Canada (North America)
- in-depth/constructive exchanges on approaches, methods or results
Dr. Ivan Berlin / Hôpital de La Pitié Salpètrière, Paris France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
PD-MER, Dr MED Michel Maillard / Service de gatro-entérologie, CHUV Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Congrès de la Société Francophone de Tabacologie Talk given at a conference Quand le microbiote arrête de fumer 30.11.2018 Montpellier, France Birrer Priska; Clair Carole;
Congrès d'automne de la Société Suisse de Médecine Interne Générale Talk given at a conference Médecine et genre: la femme, avenir du médecin durable? 21.09.2018 Montreux, Switzerland Clair Carole;
Annual meeting of the Society for Research on Nicotine and Tobacco Europe (SRNT-E) Talk given at a conference Keynote: Diabetes and smoking cessation: assessing the efficacy and metabolic impact of a smoking cessation intervention 07.09.2018 Münich, Germany Clair Carole;
Congrès de l’association Internationale des Criminologues de Langue Française (AICLF) Talk given at a conference Guérir derrière les barreaux : la santé des femmes en prison en Suisse 05.06.2018 Lausanne, Switzerland Clair Carole;
Annual meeting of the Swiss Society of General Internal Medicine Talk given at a conference Update : Gender and Health 01.06.2018 Bâle, Switzerland Clair Carole;
Annual meeting of the Swiss Society of General Internal Medicine Poster Gender bias among medical students: a pilot study using Objective Structured Clinical Examination (OSCE) situations 30.05.2018 Bâle, Switzerland Clair Carole;
Annual meeting of the Swiss Society of General Internal Medicine Talk given at a conference Médecine Interne Générale Formation continue et mobilité – recherche clinique 30.05.2018 Bâle, Switzerland Clair Carole;
8e congrès JHaS (Jeunes Médecins de Premier Recours Suisse) Talk given at a conference Workshop 2: Tabacologie quoi de neuf? 21.04.2018 Thun, Switzerland Clair Carole;
North American Primary Care Research Group (NAPCRG) annual meeting Poster Assessing the effect of change in intestinal microbiota on metabolic control after smoking cessation in people with type 2 diabetes 20.11.2017 Montréal, Canada Clair Carole;
Congrès de la Société Francophone de Tabacologie Talk given at a conference Prise en charge du patient tabagique: pratiques et variations 16.11.2017 Paris, France Clair Carole;
Congrès de la Société francophone de tabacologie Poster Diabète et tabac: une aide à l'arrêt personnalisée 16.11.2017 Paris, France Birrer Priska;
ISDM meeting Poster Tailoring a smoking cessation intervention to patient’s needs and gender specificities 02.07.2017 Lyon, France Clair Carole;
Chest Congress Talk given at a conference Clinical year in review: Smoking and e-cigarette 20.05.2017 Basel, Switzerland Clair Carole;
Annual meeting of the Swiss Society of General Internal Medicine Talk given at a conference Update: Gender and medicine 03.05.2017 Lausanne, Switzerland Clair Carole;
SRNT meeting, Firenze Poster Smoking Cessation in People with Type 2 Diabetes: an Intervention Tailored to Diabetes and Gender specificities 09.03.2017 Florence, Italy Clair Carole;
Conférence IKnot Transfert de connaissances dans la prise en charge des maladies chroniques Talk given at a conference « Peut-on transférer des concepts des sciences sociales vers la clinique? 23.11.2016 Lausanne, Switzerland Georges Aurélien;
Congrès annuel de la Société Francphone de tabacologie Talk given at a conference Tabagisme et genre 03.11.2016 Lille, France Georges Aurélien; Clair Carole;
SRNT-Europe meeting Talk given at a conference Smoking cessation treatment in Switzerland: toward more permissive prescriptions with the help from the new national guidelines 06.09.2016 Prague, Czech Republic Clair Carole;
Joint annual meeting of the Swiss Society of Cardiology/Swiss Society of Cardio-Surgery, Swiss Society of Pneumology Talk given at a conference Cardiovascular risk factors: Smoking and smoking cessation 16.06.2016 Lausanne, Switzerland Clair Carole;
Gender and Health workshop Talk given at a conference The DISCGO study: rationale, gender interim analyses and future choreography 24.05.2016 Basel, Switzerland Birrer Priska; Georges Aurélien; Clair Carole;
Conférence Diabésité Talk given at a conference Tabac et obésité 19.05.2016 Genève, Switzerland Clair Carole;
Colloque interdisciplinaire du Centre des populations vulnétables PMU Talk given at a conference Genres 12.02.2016 Lausanne, Switzerland Clair Carole;
Séminaire de l’institut Universitaire d’Histoire de la Médecine et de la Santé Publique (IUHMSP): Médecine, santé publique, société Talk given at a conference Genre et disparités: l’exemple de la dependence au tabac 11.11.2015 Lausanne, Switzerland Clair Carole;
European Gender Medicine workshop 2: sex and gender in public health and prevention Talk given at a conference Sex and gender aspects of risk factors for NCD across Europe: Tobacco 02.02.2015 Maastricht, Netherlands Clair Carole;
Colloque mensuel de tabacologie de la Policlinique Médicale Universitaire de Lausanne Individual talk Tabagisme et genre 20.01.2015 Lausanne, Switzerland Clair Carole;


Self-organised

Title Date Place

Knowledge transfer events

Active participation

Title Type of contribution Date Place Persons involved
19e Forumsant.ch Les femmes à la conquête du système de santé: quelles conséquences Talk 23.01.2018 Berne, Switzerland Clair Carole;
Information dans le cadre de la campagne de prévention de la Société Suisse de Cardiologie-Forum Elle Talk 06.10.2015 Genève, Switzerland Clair Carole;
Séance d’information tabac pour les employé-e-s de la ville de Lausanne Talk 07.01.2015 Lausanne, Switzerland Clair Carole;


Communication with the public

Communication Title Media Place Year
Media relations: print media, online media La question du genre est au cœur de la médecine 24 Heures Western Switzerland 2018
Media relations: print media, online media Les stéréotypes liés aux hommes et aux femmes s’immiscent jusque chez le médecin Le Temps Western Switzerland 2018
Media relations: print media, online media Maladies cardiaques : des biais de genre chez les généralistes Le Temps Western Switzerland 2018
Media relations: radio, television Infarctus, des symptômes souvent atypiques chez la femme RTS - Le 19h30 Western Switzerland 2017
Media relations: print media, online media Les multiples facettes du genre en médecine Bulletin Jaune Western Switzerland 2017
Media relations: print media, online media Opinion - Médecine, sexe et genre: déjouer les stéréotypes. Le Temps Western Switzerland 2017
Media relations: radio, television CQFD: Le Sexe des maladies RTS Western Switzerland 2015

Awards

Title Year
Prix du meilleur poster (congrès de la Société Francophone de Tabacologie 2017), 1er prix de la Fondation Gilbert Lagrue 2017
Obtention du titre académique Privat Docent, MER-clinique 2016

Abstract

Smoking and diabetes are both major public health burden. They act synergistically on morbidity and mortality. Micro and macro-vascular complications are dramatically increased among diabetic smokers; however people with diabetes still smoke at equivalent rates as non-diabetics. There is lack of evidence regarding interventions for smoking cessation among individuals with diabetes and the small number of existent studies has yielded mixed results. Smokers with diabetes might have more difficulties to quit because of specific barriers linked to weight gain at cessation and consequences on diabetes control. Furthermore, diabetic smokers and health professionals seem to be unaware of the potential hazards of smoking and benefits of smoking cessation on diabetes. Gender and sex-related disparities are also present. Men and women have different perceived risks and concerns about quitting smoking and its metabolic consequences. The impact of smoking cessation on diabetes control and complications might also differ between men and women.The aims of this proposal are to: 1) Assess the beliefs and needs of smokers with type 2 diabetes and health professionals regarding smoking cessation, 2) Design, tailor and pilot-test an innovative smoking cessation intervention to meet the needs of smokers with diabetes, sensitized to gender/sex specificities, 3) Assess the 12 month efficacy of a gender/diabetes tailored smoking cessation intervention in a population of smokers with type 2 diabetes, 4) Assess the impact of smoking cessation on anthropometric outcomes, diabetes control and biomarkers of insulin resistance and perform sex/gender analyses to assess if there is an interaction for sex. To reach theses aims we plan to first conduct 3 focus groups of 10 participants (10 male and 10 female smokers with type 2 diabetes, 10 healthcare professionals of both sexes) and a survey among 200 type 2 diabetic smokers to assess the beliefs, concerns and needs regarding smoking cessation. We will use findings of the focus groups and survey to tailor to gender and diabetes specificities the content and mode of delivery of a standard smoking cessation intervention. It will combine evidence-based treatments - behavioral support and nicotine replacement therapy - with 8 group sessions over 12 weeks. We will then conduct a randomized controlled trial with 520 type 2 diabetic smokers (260 men and 260 women) who will be randomly assigned to the smoking cessation intervention vs. usual care. Usual care will consist of brief advice from a physician and a booklet on smoking cessation. The main outcome will be 12-month biochemically verified continuous smoking abstinence. We then will assess the effect of smoking cessation compared to continuing smoking on anthropometric variables (weight, body-mass index, waist circumference), diabetes control (HbA1c, fasting glucose, needs in antidiabetic drugs), insulin resistance using glucose clamp techniques and other biomarkers (lipid profile, inflammatory markers). Finally we will perform analyses stratified by sex for the main and secondary outcomes to assess if there are significant differences between men and women with diabetes regarding smoking abstinence and its metabolic consequences.The understanding of metabolic and endocrinologic consequences of smoking cessation is central in order to better inform and motivate diabetic smokers. If effective such an intervention could be implemented more widely (effectiveness trial) and novel, gendered approaches could be used to prevent and change other health behaviors. The need of this work is great given the paucity of extant trials in this area, the significantly increased risk of morbidity and mortality associated with smoking and diabetes, the high prevalence of smoking among diabetics and the worldwide rapidly increasing rate of type 2 diabetes.
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