Semaglutide for Smoking Cessation in Patients With Diabetes

Inclusion Criteria: * Adults (18 years or older) with type 2 diabetes * Currently residing in Ontario * Smoke at least five cigarettes per day and willing to reduce or quit smoking within the next 6 months * Stable HbA1c ≥7.0% - 10% with no more than a 1% change over the last 3 to 6 months. * Have not used GLP-1 receptor agonists in the past six months. * Able to provide informed consent Exclusion Criteria: * Pregnant or breastfeeding individuals * Contraindication to NRT or GLP-1 RA. * Current daily use of NRT or a GLP1 RA. * Use of bupropion, cytisine, and varenicline within the last 7 days. * Use of a DPP-IV inhibitor within the last 7 days. * Initiation of a new diabetes medication within the last 3 months. * As per the product monograph, participants with the following diagnoses or disorders will be excluded; * Personal or family history of medullary thyroid cancer * Personal or family history of Multiple Endocrine Neoplasia syndrome type 2 * Diabetic ketoacidosis * Type I diabetes * Acute pancreatitis or pancreatic cancer * Acute, chronic or end-stage renal failure * Tachyarrhythmias * Unable to engage in follow-up for any reason (for example an acute mental illness, cognitive impairment, unable to speak English or French). * Other conditions deemed by the study team to interfere with participation or outcomes in the opinion of the study investigator (for example acutely unwell, life expectancy less than 1 year).