Printer Friendly

Possible Linkage between ABO Blood Groups and Type 2 Diabetes; An Observational Study from Karachi, Pakistan.

Byline: Roomana Anwar, Iftikhar Ahmed Siddiqui, Faisal Ahmed, Nida Mustafa, Saima Askari and Asher Fawwad

Key words: ABO blood groups, type 2 DM, rhesus factor.

Introduction

International Society of Blood Transfusion has defined almost 700 erythrocyte antigens and organized 30 blood group systems, of which ABO and Rh are most significant1. The blood type of a subject characterized by tiny carbohydrate epitopes depending on the presence or absence of two genes, A and B. The relevant gene is present on chromosome 9q34 having 7 exons extend over 18 kb known as ABO groups2. The ABO blood group comprises of four basic phenotypes i.e. A, B, O and AB, while Rhesus system have two phenotypes Rh+ve and Rh-ve1,3. The prevalence of ABO and Rh blood group systems vary widely across different countries, races and ethnic groups1,4. Different blood groups appeared to be related with various diseases such as gastric and duodenal ulcer, abdominal aortic aneurism, vascular diseases, several malignant tumors (esophageal cancer, pancreatic cancer, hepatocellular carcinoma), Hepatitis-B, and diabetes mellitus2,4.

Diabetes Mellitus (DM) is an uprising global threat to humanity5. According to National Diabetes Survey of Pakistan (NDSP 2016-17), prevalence of type 2 diabetes (T2DM) is 26.3%. Hence, Pakistan has around 27.4 million people suffering from diabetes above 20 years of age6. DM has a complex etiology and seems to include factors like genetic, environmental, dietary, obesity, lack of exercise and immunological factors2,7. Uncontrolled plasma glucose levels lead to life threatening micro vascular and macro vascular complications8.

Corresponding to several kinds of inherited traits, blood groups are also genetically pre- determined and thus have a strong relationship with certain diseases including diabetes. Association of ABO blood group and diabetes has been studied in past. Among diabetic subjects, high frequency of blood group A was observed in Nepal9 and Taiwan10 and blood group B in India11, Qatar12 and Italy13. Whereas it was noted that in Pakistani diabetic subjects, blood group AB and Rh-negative blood groups were more common14.

Determination of such association may be helpful to identify those subjects who are more prone to develop future diabetes, as aggressive preventive measures are required in these subjects to ultimately reduce overall disease prevalence. Therefore, this study was aimed to explore the relationship of type 2 diabetes (T2DM) with different blood groups (A, B, AB and O) and Rhesus factor (positive or negative).

Subjects and Methods

Total four hundred patients and subjects participated in this study which were categorized into two groups diabetic and non-diabetic groups. Out of them, 200 participants were already known patients with type 2 diabetes who attended outpatient department of diabetes at Baqai Medical University hospital for their routine follow-up, while 200 participants were placed in non-diabetic group, (after taking history of diabetes by research officer who was appointed to enroll study participants) who attended outpatient department of medicine at Baqai Medical University hospital for other illnesses. As per the standard ADA diagnostic criteria, fasting or random plasma glucose was tested for the confirmation of the non-diabetic status of the control subjects15.

The study was conducted from January 2015 to December 2015. The study was approved by ethical review committee of Baqai Medical University. Written informed consent was obtained from each study participant. Convenient sampling technique was used to recruit both groups. The inclusion criteria included all known patients with type 2 diabetes and non-diabetic individuals irrespective of age and gender who were willing to participate and gave informed consent. While exclusion criteria included subjects with type 1 diabetes, pregnant and lactating women. All recruitment process done under the supervision of Biochemistry Department of Baqai Medical University.

All information was gathered through one- to-one interview by a trained research officer. Blood was collected by using EDTA K2 (for haemoglobinA1c; HbA1c), sterilized disposable vacutainer tubes containing sodium fluoride (for glucose). Within 15 minutes of blood collection, the samples were sent to the laboratory department. Blood grouping procedure was based on Agglutination principle. The quantitative determination of hemoglobin A1C was done in hemosylate derived from whole blood on Roche automated clinical chemistry analyzer. Fasting plasma glucose was done after enzymatic oxidation by Glucose Oxidase.

Statistical Package for Social Sciences (SPSS) 22.0 was used for statistical analysis of the data. Student's t- test, chi-square test and two sample proportion test were performed. p value of 0.05). Blood group B was significantly more common among diabetic subjects (p-value <0.05), whereas blood group A was significantly less common in diabetic subjects as compared to non-diabetic subjects (p-value O>A>AB and Rh+ve>Rh-ve1,17-18. The results of present study were strongly in favor of these past studies expressing the similar order of frequency of ABO blood groups. Whereas, several studies from North West Nigeria, Kenya and Ethiopia have shown that blood group O was most prevalent blood group in their population which is different from our findings19-21.

Many researches had done to explore the association between ABO blood groups and diabetes mellitus in different regions of the world22- 26. Nevertheless, available data is still conflicting. Several studies had proved the relationship of ABO blood group with diabetes whereas some studies observed no association between them22-26.

The present study revealed that blood group B was most prevalent among type 2 diabetic subjects (43%). A study from the same region demonstrated similar findings that frequency of blood group B was significantly higher in type 2 diabetic subjects as compared to the general population22. This finding was also consistent to a study from Malaysia23.

The present study provided the evidence of inverse association and low incidence of blood group A in type 2 DM which is similar to a past research that blood group A was less prevalent among subjects with type 2 DM23. The same results were also highlighted in another research 24. However, some past researches provide evidence of equal distribution of ABO blood groups among diabetic and non-diabetic subjects 25.

Moreover, we found high percentage of Rhesus positive in type 2 DM subjects than healthy persons (94% vs 92%) but this finding was not statistically significant. Hence, an association of DM with Rhesus system was not proven. The outcomes were consistent with previous study conducted in India and western Algeria 26,27. Likewise, there have been various studies which do not observed any apparent association between diabetes and rhesus system 23,28.

Outcomes of the present study may have influenced by certain limitations of this study which includes relatively small sample size with the absence of community based randomized sampling technique were among the major limitations of this study. Hence, multicenter studies based on larger sample size and age matched participants in both groups are further needed to ascertain the verdicts of this study.

In conclusion, blood group B was significantly most prevalent and blood group A was significantly least prevalent among subjects with type 2 diabetes as compared to subjects without diabetes. This study did not find any significant association between type 2 diabetes and Rhesus system. As the prevalence rate of type 2 diabetes is high in Pakistan, the screening of high risk individuals is recommended and the blood group factor can also be considered to prioritize the screening individuals.

Acknowledgement

We acknowledge the support of Research department of Baqai Institute of Diabetology and Endocrinology and the OPD department of Baqai Medical University. We are also thankful to our study participants for their cooperation.

Conflict of interest: None declared.

References

1. Sing P, Sharma P, Kalhan S, Satarkar R, Gole S, Grag N. Distribution of ABO blood group and Rh (D) Factor among Blood Donors in Haryana. Int J of Biomed and Advan Res 2015; 6(3): 249-52.

2. Meo SA, Rouq FA, Suraya F, Zaidi SZ. Association of ABO and Rh blood groups with type 2 diabetes mellitus. Eur Rev Med Pharmacol Sci 2016; 20(2): 237-42.

3. Agbana BE, Daikwo MA, Metiboba LO. Patern of Blood Groups among Students of Major Ethnic Groups in Kogi State University, Anjigba-Nigeria. Int J Curr Res and Acad Rev 2015; 3(11): 1-4.

4. Farshori MP, Al-Wakid IH, AL Ibrahim IK, ALShammari AF, Alduejieman M. Distribution of ABO and Rhesus (Rh) blood group antigens in male type 2 diabetes mellitus patients in Hail region of Saudi Arabia: High incidences of diabetes mellitus in males with B+ blood type. Integr Obesity Diabetes 2016; 2: 233-8.

5. Rashid KM, Anandhasayanam A, Kannan S, Noon MSD. Prevalence of co-morbidities in Type 2 Diabetes Mellitus Patients, the Awareness Level and the Impact of Pharmacists Patient Education Program. Int J Pharma Res and Review 2015; 4(5): 11-20.

6. National; Diabetes Survey of Pakistan 2016-2017. (Accessed on 31st July 2018) Available from URL: http://phrc.org.pk/assets/final-book.pdf

7. Javed M, Akhtar MN, Muzaffar S. Frequency of ABO and Rh Blood Groups in Patients with Diabetes Mellitus. Pak JMed and Health Sci 2017; 11(1): 114-6.

8. Maori L, Ezekiel D, Bilal J, Alibe W, Haruna IL. Prevalence of Diabetes Mellitus in Patients Attending Zambuk General Hospital IOSR. J Phar and Bio Sci 2014; 9(2): 8-11.

9. Pramanik T, Pramanik S. Distribution of ABO and Rh blood groups in Nepalese medical students: a report. East Mediterr Health J 2000; 6: 156-8.

10. Lee HF, Lin YC, Lin CP, Wang CL, Chang CJ, Hsu LA. Association of blood group A with coronary artery disease in young adults in Taiwan. Intern Med 2012; 51: 1815-20.

11. Mishra M, Ahmad SZ. Obesity in association with glucose tolerance in A-B-O individuals. Indian J Appl Pure Biol 2012; 27: 119-26.

12. Bener A, Yousafzai MT. The distribution of the ABO blood groups among diabetes mellitus patients in Qatar. Niger J Clin Pract 2014; 17: 565-8.

13. Tedeschi G, Cavazzuti F. Casuistic contribution on the study of the relations between diabetes mellitus and the ABO and Rh blood groups. Prog Med (Napoli) 1959; 15: 76-82.

14. Abdul G, Waseem M, Iqbal O, Awwab K, Muhammad T. Association of diabetes mellitus with ABO and Rh blood groups. Ann Pak Inst Med Sci 2012; 8: 134-6.

15. American Diabetes Association (ADA). Standards of medical care in diabetes-2016. Diabetes Care 2016; 39: S1-S106.

16. Chandra T, Gupta G. Frequency of ABO and rhesus blood groups in blood donors. Asian J Transfus Sci 2012; 6(1): 52-3.

17. Umer KM, Waqas BM, Rehman R, Ahmed KR. Frequency of ABO and Rh (D) blood groups among blood donors in Lahore, Pakistan. Int J Adv Biol Biomed Res 2014; 2(3): 597-600.

18. Shakir M, Khan SA, Ghani E. Frequency of ABO and Rh (D) blood groups among blood donors in Rawalpindi/Islamabad area. Pak Arm Forc Med J 2012; (2): 130.

19. Erhabor O, Isaac IZ, Saidu A, Ahmed HM, Abdulrahaman Y, Festus A, et al. The distribution of ABO and Rhesus blood groups among residents of Gusau, Zamfara State, North Western Nigeria. Res Rev J Med Health Sci 2013; 2(4): 58-63.

20. Akanmu AS, Oyedeji OA, Adeyemo TA, Ogbenna AA. Estimating the risk of ABO hemolytic disease of the newborn in Lagos. J Blood Transfus 2015; 2015: 560738.

21. Alemu G, Mama M. Assessing ABO/Rh blood group frequency and association with asymptomatic malaria among blood donors attending Arba Minch blood bank, South Ethiopia. Malar Res Treat 2016; 2016: 8043768.

22. Qureshi M, Bhatti R. Frequency of ABO blood groups among the diabetes mellitus type 2 patients. J Coll Physician Surg Pak 2003; 8: 453-5.

23. Kamil M, Ali Nagi Al-Jamal H, MohdYusoff N. Association of ABO blood groups with diabetes mellitus. Lib J Med 2010; 5(1): 4847.

24. Waseem AG, Iqbal M, Khan OA, Tahir M. Association of diabetes mellitus with ABO and Rh blood groups. Ann Pak Inst Med Sci 2012; 8(2): 134-6.

25. Sharma S, Kumar J, Choudhary R, Soni ND. Study of Association between ABO Blood Groups and Diabetes Mellitus. Sch J App Med Sci 2014; 2(1A): 34-7.

26. Hegde BN. The Distribution of the ABO and Rh (D) Blood Types in Patients with Type II Diabetes Mellitus. Int J 2015; 3(11): 1561-5.

27. Dali SM, Belmokhtar F, Boazza F. The relationship between ABO/rhesus blood groups and type 2 diabetes mellitus in Maghnia, western Algeria. S Afr Fam Pract 2011; 53(6): 568-72.

28. Ganesan K, Gani SB. Relationship between ABO, RH Blood groups and diabetes mellitus, obesity in Namakkal Town, Tamilandu. Int J Adv Pharma Biol Chem2014; 3(4): 995-8.
COPYRIGHT 2019 Knowledge Bylanes
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2019 Gale, Cengage Learning. All rights reserved.

Article Details
Printer friendly Cite/link Email Feedback
Publication:Pakistan Journal of Medical Research
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2019
Words:2196
Previous Article:Internalized Stigma, Quality of Life and Self Esteem in Chronic Schizophrenic Patients.
Next Article:Comparison of Mean VO2 max in normal Weight, Overweight and Obese Students of a Local Medical College Using Analysis of Variance.
Topics:

Terms of use | Privacy policy | Copyright © 2021 Farlex, Inc. | Feedback | For webmasters