Do People with Diabetes Smoke Less on Semaglutide?

A fascinating new study in Annals of Internal Medicine asks an important question. When people receive semaglutide for type 2 diabetes, are they less likely to smoke? This is not such a random question. In fact, clinicians are reporting striking reductions in addictive behaviors by people receiving it for obesity.

So William Wang and colleagues compared the observation of tobacco use disorder in 222,942 persons receiving a variety of new diabetes medications. Compared to persons with insulin, they found a 32% reduction in tobacco use with semaglutide. Versus other GLP-1s, they saw a smaller reduction – 12%. But it was still statistically significant.

So these data do suggest that people on semaglutide for diabetes may well be less likely to smoke.

Observational Research

Now this is observational research, albeit with a novel design to help with the potential for causal inference. The approach they used is an emulation target trial design. If you care to dive into the weeds on this, JAMA has a good overview of this approach.

But for our purposes, it’s enough to know that these researchers have been rigorous in their approach, even though they cannot rule out the possibility of residual confounding. This is observational research and thus all they have is an association – an intriguing one.

Modifying Rewards for Addictive Behaviors

Nora Volkow, Director of the NIH institute for drug abuse, is a co-author on this study. She puts her finger on the reason the present observation is so intriguing:

“The main driver of why many of us overeat relates to those reinforcing positive responses that we get from eating certain foods. And it’s the same circuit for foods as for drugs,”

So this is an observation that deserves out attention. It will prompt more definitive research on the value of semaglutide and perhaps other drugs like it for treating substance use and other addictive behaviors.

Click here for the study in Annals, here and here for further reporting. For perspective on the rationale for GLP-1 agonists in tobacco use disorder, click here.

Smokers, painting by Fernand Leger / WikiArt

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July 31, 2024