REVIEW article
Front. Med.
Sec. Geriatric Medicine
Intranasal insulin and postoperative delirium in adult surgical patients: A meta-analysis and systematic review of randomized controlled trials
Provisionally accepted
- Zigong Fourth People's Hospital, Zigong, China
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Abstract Introduction: The efficacy and safety of intranasal insulin (INI) for preventing postoperative delirium (POD) remain uncertain. Methods: We searched PubMed, Web of Science, Cochrane Library, Embase, and registers from inception to July 1, 2025, for randomized controlled trials (RCTs) enrolling adult surgical patients that compared INI with control (saline) investigating the efficacy of INI for POD prevention. The risk of bias was assessed using the revised Cochrane Risk of Bias tool (RoB 2), and the certainty of evidence was evaluated with the GRADE framework. Primary and secondary outcomes were POD incidence and a comprehensive set of secondary measures (including cognitive scores, hypoglycemia rates, pain scores, and inflammatory markers), respectively. Results: A meta-analysis of 7 randomized trials (n=765) showed that INI significantly reduced the incidence of POD within 3 days postoperatively (RR = 0.35; 95% CI: 0.26-0.46; P < 0.001; I ² = 0%) and improved cognitive recovery (MMSE mean difference = 0.99; 95% CI: 0.52-1.47; P < 0.001; I² = 1.7%). INI also reduced early postoperative interleukin-6 (IL-6) levels without affecting the incidence of hypoglycemia or pain scores. Conclusion: INI may protect perioperative cognitive function, reduce POD incidence within 3 days postoperatively, and alleviate postoperative inflammation without increasing hypoglycemia risk. However, larger-scale, randomized, multicenter trials are needed to confirm clinical efficacy and establish optimal protocols. Trial registration: The protocol for this meta-analysis is available in PROSPERO (CRD42024614995)
Keywords: Meta-analysis, postoperative delirium, Systematic review, Intranasal insulin, Hypoglycemia
Received: 09 Aug 2025; Accepted: 24 Oct 2025.
Copyright: © 2025 Zhang, Song, Qiu, Li, Yu, Lu and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Bin Lu, adghkl123456@163.com
Guanyu Chen, 741755319@qq.com
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