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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.


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.


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.


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Publication:Pakistan Journal of Medical Research
Article Type:Report
Geographic Code:9PAKI
Date:Mar 31, 2019
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