AUTHOR=Zhang Hailong , Zhao Liqin , Li Min , Li Xu , Li Ruofan , Wu Di 

TITLE=Efficacy and safety of intranasal insulin on postoperative cognitive dysfunction in elderly patients after laparoscopic radical resection of colorectal cancer: a double-blind pilot study

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=16

YEAR=2024

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2024.1375841

DOI=10.3389/fnagi.2024.1375841

ISSN=1663-4365

ABSTRACT=<sec id="sec1"><title>Objective</title><p>To evaluate the efficacy and safety of intranasal insulin on postoperative cognitive dysfunction (POCD) in elderly patients after laparoscopic radical resection of colorectal cancer.</p></sec><sec id="sec2"><title>Methods</title><p>Older patients scheduled for laparoscopic radical resection of colorectal cancer at Beijing Luhe Hospital, Capital Medical University, between August 2023 and November 2023, were enrolled in this double-blind pilot study. Patients were randomized to the control and insulin groups at a 1:1 ratio. The primary outcome was the rate of POCD at postoperative 7 days.</p></sec><sec id="sec3"><title>Results</title><p>A total of 61 patients (30 in the insulin group) were analyzed. The insulin group had a significantly lower POCD rate compared with the control group at postoperative day 7 [4(13.3%) vs. 12 (38.7%), <italic>p</italic> = 0.024]. The serum levels of IL-6, TNF-α and S100β at T<sub>2-5</sub> in the insulin group were significantly lower than those of the control group (IL-6: mean difference at T<sub>2</sub>, −4.14, <italic>p</italic> = 0.036; T<sub>3</sub>, −3.84, <italic>p</italic> = 0.039; T<sub>4</sub>, −3.37, <italic>p</italic> = 0.013; T<sub>5</sub>, −2.57, <italic>p</italic> = 0.042; TNF-α: mean difference at T<sub>2</sub>, −3.19, <italic>p</italic> = 0.002; T<sub>3</sub>, −2.35, <italic>p</italic> = 0.028; T<sub>4</sub>, −2.30, <italic>p</italic> = 0.019; T<sub>5</sub>, −1.96, <italic>p</italic> = 0.0181; S100β: mean difference at T<sub>2</sub>, −8.30, <italic>p</italic> = 0.019; T<sub>3</sub>, −23.95, <italic>p</italic> = 0.020; T<sub>4</sub>, −20.01, <italic>p</italic> = 0.023; T<sub>5</sub>, −17.67, <italic>p</italic> = 0.010). No insulin allergic reactions, nasal irritation, or hypoglycemic reactions were observed in either of the groups.</p></sec><sec id="sec4"><title>Conclusion</title><p>Intranasal insulin may decrease the risk of POCD and inhibit the elevated serum IL-6, TNF-α, and S100β levels in elderly patients after laparoscopic radical resection of colorectal cancer, which proves that intranasal insulin may be a promising therapeutic option for POCD.</p></sec><sec id="sec5"><title>Clinical trial registration</title><p>Identifier, ChiCTR2300074423.</p></sec>