TOPLINE:

Intranasal insulin, which is not currently approved by the FDA, was associated with 61% reduced incidence of postoperative delirium and 41% reduced incidence of postoperative cognitive dysfunction compared to placebo in adult surgical patients, a new meta-analysis showed. It was also linked to a significant decrease in markers of neuroinflammation.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis of seven single-center, double-blinded randomized controlled trials (RCTs) that included more than 700 adults undergoing any surgical procedure in China in 2024.
• The analysis compared patients who received perioperative intranasal insulin at a dose of 20-40 IU with those who received an intranasal saline placebo.
• Outcomes included changes in the incidence of postoperative delirium and postoperative cognitive dysfunction, and changes in inflammatory marker levels.

TAKEAWAY:

• Intranasal insulin was associated with significantly reduced incidence of postoperative delirium (risk ratio [RR], 0.39; P < .001) and postoperative cognitive dysfunction (RR, 0.51; P = .02) compared to placebo.
• Compared to placebo, intranasal insulin was also linked to significantly lower postoperative interleukin-6 levels at the end of surgery (mean difference [MD], -3.9; P < .001), on day 1 (MD, -3.6; P < .001), and on day 3 (MD, -2.5; P < .001) but not on day 5.
• TNF-alpha levels were significantly lower in the intranasal insulin group at the end of surgery (MD, -3.8; P < .001), on day 3 (MD, -2.8; P < .001), and on day 5 (MD, -1.2; P = .03).
• No hypoglycemic reactions or serious adverse events were reported.

IN PRACTICE:

“Intranasal insulin represents a promising brain-targeted therapeutic intervention for preventing perioperative neurocognitive disorders through its anti-inflammatory and neuroprotective mechanisms,” the investigators wrote. 

“More and larger multicenter RCTs are necessary to further clarify the effectiveness” of the novel treatment on these outcomes and to determine its optimal formulation, dose, timing, and frequency of use, they added.

SOURCE:

This study was led by Ahmed Mostafa Amin, Al-Azhar University, Cairo, Egypt, and Ahmed Mansour, South Valley University, Qena, Egypt. It was published online on January 7 in The American Journal of Geriatric Psychiatry.

LIMITATIONS:

All of the included trials were conducted in China, limiting the generalizability of the findings. The trials only evaluated short-term outcomes during the acute postoperative delirium phase, without assessing long-term effects; and only low doses of intranasal insulin were tested to minimize the risk for adverse effects. Additionally, different insulin formulations were not compared due to the limited availability of data. 

DISCLOSURES:

The study did not receive any funding. The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.