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The latest evidence for practice

Una Adderley
Specialist Nurse
Team Leader

Which pharmaceutical remedies are effective for smoking cessation?

Smoking tobacco remains the most preventable cause of premature death and disease. Although smoking rates are declining in the developed world, they continue to rise in the developing world. A variety of pharmaceutical remedies are available to support smoking cessation but the relative effectiveness of the different preparations was unclear.

This Canadian meta-analysis sought randomised controlled trials that compared any pharmacotherapy with a placebo and measured their effectiveness on smoking cessation. Sixty-nine randomised, controlled trials met the selection criteria. The interventions examined in these trials included buproprion, vareniclene, nicotine gum, transdermal nicotine, nicotine inhalers, nicotine nasal spray and nicotine tablets. Follow-up was at six or 12 months.  

Buproprion, vareniclene, nicotine gum, transdermal nicotine, nicotine nasal spray and nicotine tablets were found to be more effective than placebo. Nicotine inhalers did not differ in terms of effectiveness from placebo.

A commentary notes that although buproprion, vareniclene and nicotine therapies appear more effective than placebo, their effectiveness compared to well-conducted cognitive support therapy, self help, clinician led support or other non-pharmacological therapies remains unknown. It seems likely that interventions that include a variety of approaches will be more successful than pharmacological approaches alone.

Reference
Eisenberg MJ, Filion K B, Yavin D et al. Pharmacoetherapies for smoking cessation: a meta analysis of randomised controlled trials. CMAJ 2008;179:135-44.

Commentary
Lamarche K. Evid Base Nurs 2009;12(1):10

Benefits of early intensive control of glucose in type 2 diabetes

The original findings of the UK Prospective Diabetes study were published over 10 years ago and proved to be a landmark in the management of diabetes. Nine years after the end of the original trial, data regarding long-term outcomes of the patients who were involved in the original trial have been reported.

A total of 4,209 patients aged between 25-65, who had newly diagnosed type 2 diabetes, were randomised to either intensive glucose control with a sulfonylurea or insulin, or conventional therapy with diet. Overweight patients were also randomised to a third group with intensive metformin therapy. Post-trial monitoring continued for an additional 10 years. 

The original analysis found significant benefits in terms of reduced risk from diabetic-related complications for those patients who had received intensive glucose control. This later study found that those benefits were sustained for up to 10 years after the end of the trial.

A commentary notes that this trial highlights the benefits of intensive glucose management for long-term prevention of microvascular and macrovascular complications and mortality in newly diagnosed patients with type 2 diabetes.

Reference
Holman RR, Paul SK, Bethel MA et al. 10 year follow up of intensive glucose control in type 2 diabetes. New Engl J Med 2008;359:1577-89.

Commentary
Sherifali D. Evid Base Nurs 2009;12(1):14.