In a target trial emulation of 222,942 patients including 5,967 semaglutide users, semaglutide was associated with significantly fewer tobacco use disorder encounters, cessation medication prescriptions, and cessation counseling vs. seven other diabetes drugs — with effects appearing within 30 days.
Effects within 30 dayssemaglutide's association with reduced TUD-related encounters appeared within the first month of treatment — faster than expected from metabolic improvements, suggesting direct neurological effects
What the researchers found
Semaglutide was associated with significantly lower tobacco use disorder-related healthcare encounters (HR 0.68-0.88), cessation medication prescriptions, and cessation counseling compared to seven other diabetes drugs, with effects emerging within 30 days.
Why it matters
Tobacco use kills over 8 million people annually, and existing cessation aids have limited effectiveness. If semaglutide reduces smoking behavior, it could provide a completely new pharmacological approach to tobacco addiction — particularly valuable since many smokers have comorbid diabetes and obesity, conditions semaglutide already treats.
The numbers in context
Nationwide US EHR database; patients with comorbid T2DM and tobacco use disorder; semaglutide vs. other diabetes drugs.
How the study worked
Target trial emulation using nationwide US electronic health records. Compared 5,967 new semaglutide users vs. users of 7 other antidiabetes medications (222,942 total) among patients with comorbid T2D and TUD. Outcomes: TUD-related medical encounters, cessation medication prescriptions, and cessation counseling over 12 months. Cox proportional hazards and Kaplan-Meier analyses.
Who was studied
US patients with type 2 diabetes and tobacco use disorders
What this study cannot tell us
Observational study — cannot prove causation. Key limitation: lower TUD-related encounters could reflect reduced care-seeking rather than reduced smoking. No data on actual cigarette consumption or smoking status. Semaglutide users may differ systematically from comparator groups. Only T2D patients with documented TUD studied. Medication adherence not verified.
How to read the evidence
Moderate — large target trial emulation with consistent results across comparator groups. However, observational design and reliance on healthcare encounter data rather than direct smoking measurement limit conclusions.
When this study was published
Published in 2024 in Annals of Internal Medicine, among the first systematic examinations of semaglutide's association with tobacco use disorder.
The bigger picture
This study, alongside similar findings for alcohol use disorder and Alzheimer's, suggests semaglutide may broadly modulate brain reward and addiction circuits through GLP-1 receptor activation. The rapid onset (within 30 days) suggests a direct neurological effect rather than an indirect benefit of weight loss or metabolic improvement. If confirmed in RCTs, GLP-1 agonists could become a multi-purpose treatment addressing addiction, metabolic disease, and neurodegeneration simultaneously.
Questions still open
- Do semaglutide users actually smoke less, or do they just have fewer smoking-related medical encounters?
- Would semaglutide be effective as a smoking cessation aid in non-diabetic smokers?
- Is the rapid 30-day onset of effect consistent with direct GLP-1 receptor modulation of reward circuits?
Common questions
Could semaglutide help people quit smoking?
Why would a diabetes drug affect smoking?
Read the original research
Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes : Target Trial Emulation Using Real-World Data.
Annals of internal medicine, 177(8), 1016-1027
Citation
Wang, William; Volkow, Nora D; Berger, Nathan A; Davis, Pamela B; Kaelber, David C; Xu, Rong. (2024). Association of Semaglutide With Tobacco Use Disorder in Patients With Type 2 Diabetes : Target Trial Emulation Using Real-World Data.. Annals of internal medicine, 177(8), 1016-1027. https://doi.org/10.7326/M23-2718