• Users Online: 1403
  • Print this page
  • Email this page

 Table of Contents  
Year : 2022  |  Volume : 13  |  Issue : 3  |  Page : 227-234

Prevalence of diabetes in Odisha, India: A systematic review and meta analysis

1 Department of Community Medicine, SLN Medical College, Koraput, India
2 Department of Medicine, SLN Medical College, Koraput, India
3 Department of Biochemistry, MKCG Medical College, Bhubaneswar, Odisha, India
4 Scientist- C, Regional Medical Research Centre, Bhubaneswar, Odisha, India

Date of Submission13-May-2022
Date of Decision19-Jun-2022
Date of Acceptance08-Jul-2022
Date of Web Publication26-Sep-2022

Correspondence Address:
Dr. Purna Chandra Pradhan
Department of Community Medicine, SLN Medical College, Koraput, Odisha
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jod.jod_53_22

Rights and Permissions

Objective: The objective of this review was to summarize and compare the estimates of diabetes among adults in community and hospital-based settings in Odisha, India. Introduction: Diabetes Mellitus (DM) is a major non-communicable disease as well as a risk factor. In a vast and diverse country such as India, where health is a state subject, regional synthesized and up to date estimates of DM burden is necessary for informed policy making. No such estimates are currently available for the state of Odisha. Materials and Methods: Peer‑reviewed published original research articles related to prevalence DM in the state of Odisha published between 2011 and 2022 were retrieved from 4 medical databases and analysed. Study screening, selection, data extraction and critical appraisal was done by 2 independent review authors. Data synthesis and assessment of certainty of the evidence was done in meta-analysis of the results. Results: A total of 15 studies, that included 17339 participants, with overall good methodological quality were included in the review. The overall prevalence of DM among adults in the state of Odisha based on Community based surveys was 6.8% (95% CI: 2.3–13.4%). The prevalence in older adults aged 60 years or above is higher at 22.2% (95% CI: 8.6–39.9%). The prevalence in studies that relied on self-reported methods of screening was 4.8% (95% CI: 1.7–9.3%) as compared to those that diagnosed participants based on standard criteria (12.1%; 95% CI: 8.1–16.7%). Conclusions: We found a high prevalence of DM in the state of Odisha, which was higher than previously available national and regional estimates. This prevalence was much lower in community-based studies and in self-reported surveys pointing towards significant under diagnosis of hypertension in the state of Odisha and highlighting a need for a robust community-based screening program among adults in the state.

Keywords: Adults, diabetes, high blood sugar, Odisha, prevalence

How to cite this article:
Supakar S, Nayak S, Behera L, Kshatri J, Pradhan PC. Prevalence of diabetes in Odisha, India: A systematic review and meta analysis. J Diabetol 2022;13:227-34

How to cite this URL:
Supakar S, Nayak S, Behera L, Kshatri J, Pradhan PC. Prevalence of diabetes in Odisha, India: A systematic review and meta analysis. J Diabetol [serial online] 2022 [cited 2022 Dec 7];13:227-34. Available from: https://www.journalofdiabetology.org/text.asp?2022/13/3/227/357133

  Introduction Top


Diabetes Mellitus (DM) or increased blood sugar is a serious endocrine disorder that is a major cause of kidney failure, blindness, heart attacks, stroke, and lower limb amputation worldwide whose prevalence has been rising more rapidly in low- and middle-income countries.[1],[2] DM is a significant public health challenge with over half a billion people in the world are estimated to have DM, leading to a loss of around 80 million years due to resulting disability.[3],[4] The prevalence of DM among Indian adults is significant with estimates of about 70 million Indians living with the disease at present.[5],[6],[7] A large proportion of these are not aware of this condition, thereby accentuating the challenge.

In addition to this, there is significant regional variation among states in a country of the size and diversity of India.[8] With available preventive and management strategies, early identification is a key component that has to be part of any such intervention programs. Health being a state subject, it is important to have robust estimates of the epidemiology of DM at the state level for assisting policy makers in evidence informed decision making.

Odisha is an eastern state of India which has generally been a laggard in terms of health indicators in the country, thereby requiring special attention at the national and state level. While there are multiple surveys carried out in various settings, there is a lack of synthesized evidence of comparable data from the state of Odisha, not just on DM burden but many other health challenges. Additionally, there remains a gap of under reporting and under diagnosis regarding DM leading to clear distinction of prevalence estimates of self-reported and newly physician diagnosed estimates of burden of DM as well as a difference in hospital based and community-based studies.[9]

Synthesized evidence on the burden of this common disorder is necessary for evidence informed policy making towards preventive and curative programs in the state. We carried out a preliminary search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the JBI Evidence Synthesis and no current or underway systematic reviews on the topic and context were identified.


With this background this systematic review and meta-analysis was carried out to identify, summarize and compare the estimates the prevalence of DM among adults in community and hospital-based settings in the state of Odisha, India.

Review question

What is the prevalence of diabetes among adults in community and hospital based settings in Odisha, India?

  Materials and Methods Top

This systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of prevalence and incidence.[10] This review was conducted in accordance with an a priori protocol with no deviations. The protocol was registered on institutional internal library KOHA server of ICMR and the Prospero registration was not done. We used the following selection criteria for the studies:

Eligibility criteria

Inclusion criteria


All studies that reported the condition of interest among adults aged 18 years or older and carried out in the state of Odisha, in part or exclusively, were included in our review.


We included studies that reported prevalence of DM, either as self-reported or measured by physician/health-worker, either as part of primary or secondary objectives of the study or even reported as a covariate.


As the focus of the review is to summarize the prevalence of DM, we have excluded studies that included reports of the same during pregnancy such as Gestational DM. We have also excluded studies for which full text was not available/accessible even after contacting authors or for which age classification of participants was not available/reported. For studies presenting duplicate data on DM from same sample, we have included only one of them. We have included studies reporting data from the last decade (i.e. Jan 1st 2011 to Jan 1st 2022) in order to be fairly contemporary in use of the data sources.

Types of studies

Descriptive or analytical observational studies including baseline reports of longitudinal cohort studies and analytical cross-sectional studies were considered for inclusion. Experimental study and qualitative designs were excluded. We also excluded conference abstracts or presentations, protocols, books/book chapters, preprints, reviews—narrative or systematic, letters/news articles/opinions/commentaries.

Information sources’

Search strategy

A comprehensive systematic search was performed on January 1, 2022, in the following electronic databases: Medline (via PubMed), Embase (via Ovid), PsycINFO (via Ovid), and CINAHL (via EBSCOHost). In order to keep the search strategy sensitive enough, the databases were searched for those studies that had a mention of the name of the state of Odisha and its variations as well as the name of all the districts and major cities in the state within their abstracts and titles. The detailed search strategy template used is provided in Appendix-1 for MEDLINE. The search strategy, including all identified keywords and index terms, was adapted for each included database and/or information source. The reference list of all included sources of evidence was screened for additional studies.

Study selection

Following the search, all identified citations were collated and uploaded into Mendeley reference management software and duplicates were removed. Following a pilot test, titles and abstracts were screened by two reviewers independently for assessment against the inclusion criteria, using Rayyan platform. Potentially relevant studies were retrieved in full and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI) (JBI, Adelaide, Australia).[11] The full text of included articles were assessed in detail against the inclusion criteria by two reviewers. Reasons for exclusion of papers at full text that do not meet the inclusion criteria were recorded and reported. The discrepancies were discussed and resolved by consensus. In case of a disagreement, a third author made the decision. The excluded studies and 15 included studies are listed in Appendices.

Assessment of methodological quality

Eligible studies were critically appraised by two independent reviewers for methodological quality using standardized critical appraisal instruments from JBI for observational studies.[12] This includes assessment of appropriateness of sample frame, sampling, sample size, study setting, data analysis, methods for reliable measurement of DM, statistical analysis and response rates. Any disagreements that arose were resolved through discussion. All studies, regardless of the results of their methodological quality, underwent data extraction and synthesis (where possible).

Data extraction

Data was extracted from studies included in the review by two independent reviewers using a modified version of the standardized data extraction tool for prevalence and incidence available in JBI SUMARI.[13] The data extracted included specific details about the condition, populations, study methods and proportions of interest on DM. The tool used is given in appendix.

Data synthesis

Narrative synthesis of relevant findings from the included studies and the subgroups of interest was done. Studies, where possible, were pooled in statistical meta-analysis using JBI SUMARI. Effect sizes were expressed as a proportion with 95% confidence intervals around the summary estimate. Statistical analyses were performed using a random effects model using the double arscine transformation approach. Subgroup analyses was conducted where there was sufficient data to investigate. Heterogeneity was assessed statistically using the standard chi-squared and I squared tests. The JBI SUMARI software was used for all statistical analysis.

  Results Top

Study inclusion

We included a total of 15 articles in this review that were identified from screening of 2285 articles from database searches and 12 from citation searching. The details of exclusions and reasons are shown in the PRISMA flow chart below [Figure 1].
Figure 1: Study selection diagram (PRISMA)

Click here to view

Methodological quality

The methodological quality of the included studies as a whole was high based on the results of the critical appraisal. The studies reported moderate reliability in reporting methods used for screening and/or identification of DM. Adequate sample size is considered over 225 for community-based studies and 100 for special situations and hospital based studies. The details of the critical appraisal findings of the included studies are provided in [Table 1].
Table 1: Methodological quality of the included studies

Click here to view

Characteristics of included studies

The study synthesised results from 17339 participants in total collected during the past decade. While 4 studies were exclusively among older adults, the remaining included all adults aged either 18 or 20 years and above. All studies included both males and females (No studies reported transgenders or other genders). Most of the studies were conducted in community-based settings (n = 8) followed by tertiary care hospitals and primary healthcare facilities. Only 6 studies relied on self-reported information on occurrence of DM while the rest were based on laboratory diagnosis by trained health care workers using the acceptable standard definition of either fasting blood sugar or glycosylated haemoglobin. The descriptive characteristics of the included studies are summarized in [Table 2] below.
Table 2: Descriptive summary of the included studies

Click here to view

Review findings

The pooled prevalence of DM from community-based studies in Odisha among adults is 6.8% (95% CI: 2.3–13.4%) based on 4 studies. Similarly, the prevalence in older adults aged 60 years or above is higher at 22.2% (95% CI: 8.6–39.9%) as shown in [Figure 2] below. The prevalence of DM when studies relied on self-reported methods of screening was 4.8% (95% CI: 1.7–9.3%). In contrast, the prevalence was much higher in studies that diagnosed participants based on standard criteria at 12.1% (95% CI: 8.1–16.7%). The difference is highlighted in [Figure 3] below. Prevalence among patients attending out-patient departments is also higher at 11.5% (95% CI: 7.2–16.5%). DM is a major chronic condition present in over 36% of people with at least one long term chronic condition. All meta-analysis reported a high degree of heterogeneity in the study results.
Figure 2: Community based Prevalence of Diabetes in Odisha (2011–21)

Click here to view
Figure 3: Prevalence of Diabetes using Self-reported vs. newly diagnosed methods in Odisha (2011–21)

Click here to view

  Discussion Top

This review summarises the evidence on burden of diabetes in the state of Orissa in the past decade. The review included 15 studies representing information from over 17000 adult participants from different settings.

The prevalence of DM among adults in the state of Odisha based on Community based surveys was around 7% in all adults and over 22% in older adults. While there has been an increasing trend in the burden of DM across India, the state of Odisha has generally reported a low prevalence of DM between 1–2% as summarized by Unnikrishnan et al. [5] Our review has found a significantly higher prevalence than previous reports from the region and is closer the global burden of disease estimates that predict a very steep rise in prevalence of DM in Odisha.[8] Our findings corroborate national estimates for India by Jayawardena et.al. (12%) as well as the latest National family Health Survey (NFHS-5) report that found a significantly higher prevalence of elevated (>140 mg/dl) blood sugar or taking medicine to control blood sugar level to be 17% and 14% in men and women respectively in Odisha.[6],[29],[30] This is even higher than the national estimates of prevalence of the same indicators at 15% and 13% in men and women respectively. Although elevated blood sugar can be considered only a proxy marker for DM diagnosis, this data indicates that the possible burden of DM is higher than previous estimates in Odisha.

The estimates of DM prevalence were higher in older adults at around 22%. This is reflecting the fact that age is a major risk factor of DM, as with many other chronic conditions. Our findings are however higher than the national estimates provided among older adults by the Longitudinal Aging Study of India (LASI) that reports a prevalence of around 15% in the same age group.[31] Although we were not able to assess this, among elderly age 60 and above, the prevalence of DM has been reported to be three times higher in those living in urban areas (26%) than those living in rural areas (9%), most possibly linked to under diagnosis.[31] This rural urban schism is a global phenomenon which is more marked in low income settings such as India and Odisha.[3] Subgroup and sensitivity analyses did not explain the significant heterogeneity in the meta-analysis.

This under diagnosis of DM is also highlighted in our finding that out-patient based prevalence estimates from hospitals are almost twice greater than the community-based estimates in Odisha. Although the measurement of blood sugar by health workers at the community level is now well accepted and in practice, there still remains a large gap between estimates of ‘self-reported’ and laboratory confirmed diagnoses of DM. Studies that relied on self-reported measures of DM have reported almost 2.5 times lower prevalence than lab confirmed estimates. This shows a significant gap in the community level knowledge of one’s own DM status, which is a critical first step in remedial measures.

Our meta-analysis reported a high degree of heterogeneity, and this is a potential limitation of the study. The review has included studies with good methodological quality. However, variations in settings and other potential bias in individual studies may impact the findings. We were unable to estimate publication bias due to insufficient studies from similar categories.

  Conclusions Top

Our study highlights the need for sub national estimates of prevalence of a common and important disorder, Diabetes, in a large and diverse nation such as India. We found a higher than previously reported prevalence of DM in the state of Odisha. This prevalence was much lower in community-based studies and in self-reported surveys pointing towards significant under diagnosis of DM in the state of Odisha.

Recommendations for practice or policy

The findings imply a need for a robust community-based screening program among adults in the state and linking with facilities for timely diagnosis and management of DM. The modalities of the community-based screening being followed under the National program for prevention and control of cardiovascular diseases, cancer and stroke may need improvements in the diagnostic pathways to better identify patients with DM in the community.

Recommendations for research

While there is adequate evidence on the burden of DM in the state, research may now be aimed at designing and testing specific interventions that may improve the under-diagnosis rates. Further, reliance on self-reported measures of DM is a potential source of bias and may be avoided in future community-based research studies.

Financial support and sponsorship

No external funding was received for this review.

Conflicts of interest

The authors declare no potential conflict of interest or any personal, financial, professional, or intellectual bias for any of the authors listed on the manuscript.

Author contributions

All authors contributed equally to the designing of the study, data extraction and manuscript preparation. Searches were run and meta-analysis was carried out by JSK and PP.

  References Top

WHO. Diabetes Factsheet [Internet]. [cited 2022 May 12]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. [Last accessed on 2022 Feb 20].  Back to cited text no. 1
Magliano DJ, Islam RM, Barr ELM, Gregg EW, Pavkov ME, Harding JL, et al. Trends in incidence of total or type 2 diabetes: Systematic review. BMJ 2019;366:l5003.  Back to cited text no. 2
Zabetian A, Sanchez IM, Narayan KM, Hwang CK, Ali MK Global rural diabetes prevalence: A systematic review and meta-analysis covering 1990-2012. Diabetes Res Clin Pract 2014;104:206-13.  Back to cited text no. 3
Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: An analysis from 1990 to 2025. Sci Rep 2020;10:544-9.  Back to cited text no. 4
Unnikrishnan R, Anjana RM, Mohan V Diabetes mellitus and its complications in india. Nat Rev Endocrinol 2016;12:357-70.  Back to cited text no. 5
Jayawardena R, Ranasinghe P, Byrne NM, Soares MJ, Katulanda P, Hills AP Prevalence and trends of the diabetes epidemic in South Asia: A systematic review and meta-analysis [Internet]. 2012. Available from: http://www.biomedcentral.com/1471–2458/12/380. [Last accessed on 2022 Feb 18].  Back to cited text no. 6
IDF Diabetes Atlas 2021 | IDF Diabetes Atlas [Internet]. [cited 2022 May 12]. Available from: https://diabetesatlas.org/atlas/tenth-edition/. [Last accessed on 2022 Feb 20].  Back to cited text no. 7
Tandon N, Anjana RM, Mohan V, Kaur T, Afshin A, Ong K, et al. The increasing burden of diabetes and variations among the states of India: The Global Burden of Disease Study 1990–2016. The Lancet Global Health 2018;6:e1352-62.  Back to cited text no. 8
Kaveeshwar SA, Cornwall J The current state of diabetes mellitus in india. Australas Med J 2014;7:45-8.  Back to cited text no. 9
Munn Z, Moola S, Lisy K, Riitano D, Tufanaru C Chapter 5: Systematic reviews of prevalence and incidence. In: JBI Manual for Evidence Synthesis; 2020. p. 45-9.  Back to cited text no. 10
Home Page | jbisumari [Internet]. [cited 2022 May 10]. Available from: https://sumari.jbi.global/. [Last accessed on 2022 Feb 20].  Back to cited text no. 11
critical-appraisal-tools - Critical Appraisal Tools | JBI [Internet]. [cited 2022 May 12]. Available from: https://jbi.global/critical-appraisal-tools. [Last accessed on 2022 Feb 20].  Back to cited text no. 12
- Home Page | jbisumari [Internet]. [cited 2022 May 12]. Available from: https://sumari.jbi.global/. [Last accessed on 2022 Feb 18].  Back to cited text no. 13
Ashe S, Routray D Prevalence, associated risk factors of depression and mental health needs among geriatric population of an urban slum, Cuttack, Odisha. Int J Geriatr Psychiatry 2019;34:1799-807.  Back to cited text no. 14
Dash SC, Agarwal SK, Panigrahi A, Mishra J, Dash D Diabetes, hypertension and kidney disease combination “Dhkd syndrome” is common in India. J Assoc Physicians India 2018;66:30-3.  Back to cited text no. 15
Dehury P, Sahu DP, Giri PP, Bhatia V The pattern of morbidity and use of social security schemes among the steel plant workers in an industrial district of Odisha. Indian J Community Med 2021;46:739-43.  Back to cited text no. 16
Banjare P, Pradhan J Socio-economic inequalities in the prevalence of multi-morbidity among the rural elderly in bargarh district of Odisha (India). Plos One 2014;9:e97832.  Back to cited text no. 17
Swain S, Pati S, Pati S A chart review of morbidity patterns among adult patients attending primary care setting in Urban Odisha, India: An international classification of primary care experience. J Family Med Prim Care 2017;6:316-22.  Back to cited text no. 18
Sarkar A, Mohapatra I, Rout RN, Thakur B Morbidity pattern and healthcare seeking behavior among the elderly in an urban settlement of Bhubaneswar, Odisha. J Family Med Prim Care 2019;8:944-9.  Back to cited text no. 19
Prasad DS, Kabir Z, Dash AK, Das BC Effect of obesity on cardiometabolic risk factors in Asian Indians. J Cardiovasc Dis Res 2013;4:116-22.  Back to cited text no. 20
Pati S, Mahapatra P, Kanungo S, Uddin A, Sahoo KC Managing multimorbidity (Multiple Chronic Diseases) amid COVID-19 pandemic: A community based study from Odisha, India. Frontiers in Public Health 2021;8:645-51.  Back to cited text no. 21
Pati S, Sinha R, Panda M, Puri P, Pati S Profile of multimorbidity in outpatients attending public healthcare settings: A descriptive cross-sectional study from Odisha, India. J Family Med Prim Care 2021;10:2900-14.  Back to cited text no. 22
Pati S, Swain S, Hussain MA, Kadam S, Salisbury C Prevalence, correlates, and outcomes of multimorbidity among patients attending primary care in Odisha, India. Ann Fam Med 2015;13:446-50.  Back to cited text no. 23
Pati S, Mahapatra P, Dwivedi R, Athe R, Sahoo KC, Samal M, et al. Multimorbidity and its outcomes among patients attending psychiatric care settings: An observational study from Odisha, India. Front Public Health 2021;8:184-92.  Back to cited text no. 24
Palo SK, Kanungo S, Samal M, Priyadarshini S, Sahoo D, Pati S Water, sanitation, and hygiene (wash) practices and morbidity status in a rural community: Findings from a cross-sectional study in Odisha, India. J Prev Med Hyg 2021;62:E392-8.  Back to cited text no. 25
Palo SK, Swain S, Priyadarshini S, Behera B, Pati S Epidemiology of obesity and its related morbidities among rural population attending a primary health centre of Odisha, India. J Family Med Prim Care 2019;8:203-8.  Back to cited text no. 26
Mohanty NK, Sahoo KC, Pati S, Sahu AK, Mohanty R Prevalence of chronic kidney disease in cuttack district of Odisha, India. Int J Env Res Public Health 2020;17:982-90.  Back to cited text no. 27
Kshatri JS, Palo SK, Bhoi T, Barik SR, Pati S Prevalence and patterns of multimorbidity among rural elderly: Findings of the Ahsets study. Front Public Health 2020;8:582663.  Back to cited text no. 28
Ministry of Health and Family Welfare Key Indicators 22 STATES/UTs FROM PHASE-I. Available from: mohfw.gov.in [Last accessed on 2022 Feb 20].  Back to cited text no. 29
Ministry of Health and Family Welfare State Fact Sheet Odisha. Available from: mohfw.gov.in. [Last accessed on 2022 Feb 20].  Back to cited text no. 30
Longitudinal Ageing Study in India (LASI) Fact sheets states/uts National Programme For Health Care of Elderly & International Institute for Population Sciences Ministry of Health & Family Welfare Government of India. Available from: iips.org.in. [Last accessed on 2022 Jan 1].  Back to cited text no. 31


  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2]


Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

  In this article
Materials and Me...
Article Figures
Article Tables

 Article Access Statistics
    PDF Downloaded130    
    Comments [Add]    

Recommend this journal