Perioperative medicine & outcomes
Effect of preoperative intranasal insulin on postoperative delirium in adult surgical patients: a systematic review, meta-analysis, and trial sequential analysis
Pooled resultResult — go to the resultOdds ratio 0.24 95% CI 0.17–0.34Authors' conclusion
Preoperative intranasal insulin is a safe and effective strategy to reduce POD, likely through central anti-inflammatory mechanisms, without compromising glycemic stability.
Study context
- Population
- Adult surgical patients (randomized controlled trials (RCTs) from China)
- Participants
- 888 patients · 8 RCTs
- Comparison
- Preoperative intranasal insulin vs placebo
- Intranasal insulinn = 481
- Placebon = 407reference
- Outcome
- Incidence of postoperative delirium (POD)
Methodological detailstrial sequential analysis, random-effects models
- Trial sequential analysis
- Random-effects models
Pooled result
As reported in the abstract
Odds ratio
0.24
95% CI 0.17–0.34
P < 0.001
Intranasal insulin vs Placebo
OR 0.24 (95% CI 0.17–0.34); P < 0.001
Further pooled results
IL-6
- Significant reduction in IL-6
- −2.52 (MD −2.52; 95% CI −3.45 to −1.58)
TNF-α
- Significant reduction in TNF-α
- −5.02 (MD −5.02; 95% CI −8.67 to −1.36)
Serum or CSF glucose, HOMA-IR
- No significant differences in serum or CSF glucose, or HOMA-IR
Safety
Hypoglycemia or serious adverse events
- None reported
- 0
Original publication
Effect of preoperative intranasal insulin on postoperative delirium in adult surgical patients: a systematic review, meta-analysis, and trial sequential analysis. Perioper Med (Lond). Published 20 March 2026. doi:10.
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