Safety and efficacy of intranasal insulin in patients with Alzheimer's disease: a systematic review and meta-analysis

Yosra Hussein AboEl-Azm; Mohamed El-Samahy; Nada Ibrahim Hendi; Amina Arar; Noha Samy Yasen; Shrouk Ramadan; Esraa M Zedan; Nada Mostafa Al-Dardery; Abdulrhman Khaity

Safety and efficacy of intranasal insulin in patients with Alzheimer's disease: a systematic review and meta-analysis

J Clin Transl Res. 2023 Jul 12;9(4):222-235. eCollection 2023 Aug 31.

Authors

Yosra Hussein AboEl-Azm¹, Mohamed El-Samahy^{1

2}, Nada Ibrahim Hendi^{2

3}, Amina Arar^{2

4}, Noha Samy Yasen⁵, Shrouk Ramadan^{2

3}, Esraa M Zedan^{2

6}, Nada Mostafa Al-Dardery^{2

7}, Abdulrhman Khaity^{2

8}

Affiliations

¹ Department of Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt.
² Department of Medicine, Medical Research Group of Egypt, Cairo 44523, Egypt.
³ Department of Medicine, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt.
⁴ Department of Medicine, Faculty of Medicine, Algiers University, Algeria, 16111, Algeria.
⁵ Department of Radiology, Faculty of Applied Medical Sciences, Misr University for Science and Technology, Cairo, 12566, Egypt.
⁶ Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, 11651, Egypt.
⁷ Department of Medicine, Faculty of Medicine, Fayoum University, Fayoum, 63514, Egypt.
⁸ Department of Medicine, Faculty of Medicine, Elrazi University, Khartoum, 11115, Sudan.

PMID: 37564252
PMCID: PMC10411979

Abstract

Background and aim: We performed this meta-analysis to evaluate the safety and efficacy of intranasal insulin in Alzheimer's disease (AD) patients.

Methods: A literature search was conducted for PubMed, Scopus, and Web of Science from inception until August 2022. Documents were screened for qualified articles, and all concerned outcomes were pooled as risk ratios or mean difference (MD) in the meta-analysis models using Review Manager (RevMan version 5.4).

Results: Our results from 12 studies favored intranasal insulin over placebo in terms of Alzheimer Disease's Assessment Scale-cognitive subscale (ADAS-cog) 20 IU, (MD = -0.13, 95% CI [-0.22, -0.05], P = 0.003). The overall effect did not favor either of the two groups for ADAS-cog 40 IU, memory composite 20 IU and 40 IU, and adverse events (MD = -0.08, 95% CI [-0.16, 0.01], P = 0.08), (MD = 0.65, 95% CI [-0.08, 1.39], P = 0.08), (MD = 0.25, 95% CI [-0.09, 0.6], P = 0.15), and (MD = 1.28, 95% CI [0.75, 2.21], P = 0.36), respectively.

Conclusion: Ultimately, this meta-analysis showed that intranasal insulin in small doses (20 IU) significantly affects patients with AD. Further studies are recommended on reliable insulin delivery devices to increase insulin in the central nervous system.

Relevance for patients: Intranasal insulin has shown promising results in treating patients with AD. The lower doses (20 IU) can play a positive role in improving the disease. As research continues, it is likely that this treatment will become more widely accepted and utilized in clinical practice.

Keywords: Alzheimer’s disease; intranasal insulin; mild cognitive impairment.

Publication types

Review