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Journal of Clinical and Translational Research 2023; 9(4): 222-235
Journal of Clinical and Translational Research
Journal homepage: http://www.jctres.com/en/home
REVIEW ARTICLE
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 ,
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Shrouk Ramadan , Esraa M Zedan , Nada Mostafa Al-dardery , Abdulrhman Khaity *
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1 Department of Medicine, Faculty of Medicine, Zagazig University, Zagazig, 44519, Egypt, Department of Medicine, Medical Research Group of Egypt,
Cairo 44523, Egypt, Department of Medicine, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt, Department of Medicine, Faculty of
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Medicine, Algiers University, Algeria, 16111, Algeria, Department of Radiology, Faculty of Applied Medical Sciences, Misr University for Science and
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Technology, Cairo, 12566, Egypt, Department of Medicine, Faculty of Medicine, Al-Azhar University, Cairo, 11651, Egypt, Department of Medicine,
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Faculty of Medicine, Fayoum University, Fayoum, 63514, Egypt, Department of Medicine, Faculty of Medicine, Elrazi University, Khartoum, 11115, Sudan
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ARTICLE INFO ABSTRACT
Article history: Background and Aim: We performed this meta-analysis to evaluate the safety and efficacy of
Received: January 18, 2023 intranasal insulin in Alzheimer’s disease (AD) patients.
Revised: February 28, 2023 Methods: A literature search was conducted for PubMed, Scopus, and Web of Science from inception
Accepted: March 23, 2023 until August 2022. Documents were screened for qualified articles, and all concerned outcomes were
Published online: July 12, 2023 pooled as risk ratios or mean difference (MD) in the meta-analysis models using Review Manager
(RevMan version 5.4).
Keywords: Results: Our results from 12 studies favored intranasal insulin over placebo in terms of
Alzheimer’s disease Alzheimer Disease’s Assessment Scale-cognitive subscale (ADAS-cog) 20 IU, (MD = −0.13, 95%
intranasal insulin CI [−0.22, −0.05], P = 0.003). The overall effect did not favor either of the two groups for ADAS-cog
mild cognitive impairment 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),
*Corresponding authors: and (MD = 1.28, 95% CI [0.75, 2.21], P = 0.36), respectively.
Abdulrhman Khaity Conclusion: Ultimately, this meta-analysis showed that intranasal insulin in small doses (20 IU)
Faculty of Medicine, Elrazi University, 11115 significantly affects patients with AD. Further studies are recommended on reliable insulin delivery
Khartoum, Sudan. devices to increase insulin in the central nervous system.
Tel: +249999255031 Relevance for Patients: Intranasal insulin has shown promising results in treating patients with AD.
Email: abdulrhman.marwan.khaity@gmail.com 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.
© 2023 Author(s). This is an Open-Access
article distributed under the terms of the
Creative Commons Attribution-Noncommercial
License, permitting all non-commercial use, 1. Introduction
distribution, and reproduction in any medium,
provided the original work is properly cited. Alzheimer’s disease (AD) is a chronic neurodegenerative illness characterized by
changes in behavior and personality, cognitive impairment, and memory loss [1]. Major
neuropathological features of AD are thought to be the buildup of extracellular amyloid/
senile plaques made of intracellular neurofibrillary tangles and amyloid-(A). It is worth
mentioning that AD-sensitive brain areas exhibit substantial abnormalities in glucose
metabolism and reduced neuron use of glucose as a result of disruptions in the insulin
signaling pathway [2].
Several studies recently suggested that insulin may be essential in preserving the
brain’s mitochondrial balance and cerebral bioenergetics [3]. In addition, it could have an
impact on the clearance of the significant factors in the path mechanism of AD, including
DOI: http://dx.doi.org/10.18053/jctres.09.202304.23-00013
