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Abstract Background: Type 2 diabetes mellitus (T2DM) is a rapidly growing public health problem with a strong genetic component, particularly among South Asian populations. In recent years, the ABO blood group system has been explored as a potential biological factor influencing susceptibility to various metabolic disorders, including diabetes mellitus. However, evidence from Indian populations, especially from the Kashmir region, remains limited and inconclusive. Objectives: To assess the association between ABO blood groups and type 2 diabetes mellitus and to identify blood groups that may be more or less prone to developing the disease. Materials and Methods: This descriptive cross-sectional study was conducted at Government Medical College Anantnag and its associated hospital over six months. A total of 300 confirmed cases of T2DM attending outpatient and inpatient services were included after informed consent. Demographic details, duration of diabetes, and comorbidities were recorded. ABO and Rh blood grouping was performed using the slide (direct) method. Data were analyzed descriptively. Results: Of the 300 participants, 53.7% were female and 46.3% were male. Most patients belonged to the 31–60-year age group (61%). Blood group B⁺ was the most prevalent among diabetic patients (31.7%), followed by A⁺ (23.7%) and O⁺ (18.3%), while the lowest prevalence was observed in A⁻ and AB⁻ groups (1.3% each). The majority of participants (65%) had a duration of diabetes of less than five years. Conclusion: The study demonstrates a higher prevalence of type 2 diabetes mellitus among individuals with blood group B, suggesting a possible association between ABO blood group and susceptibility to T2DM. Blood group B may represent a potential genetic risk marker. Larger multicentric and molecular-level studies are required to further elucidate this relationship.
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Diabetes mellitus is rapidly emerging as a global epidemic and currently ranks as the sixth leading cause of death worldwide. Individuals with diabetes have nearly twice the risk of mortality compared with non‑diabetics of the same age. The global burden of diabetes is projected to rise from approximately 220 million people in 2010 to nearly 300 million by 2025.¹˒²˒³ A stronger genetic predisposition to diabetes has also been documented among the Indian population.⁴˒⁵˒⁶ Diabetes mellitus is a state of chronic hyperglycemia in which carbohydrate and lipid homeostasis is inadequately regulated by insulin. It is broadly classified into type 1 and type 2 diabetes mellitus. Type 2 diabetes mellitus (T2DM) is far more prevalent and is characterized by varying degrees of insulin resistance, impaired insulin secretion, and increased hepatic glucose production.¹˒⁷˒⁸˒⁹T2DM is a multifactorial disease resulting from a complex interaction between genetic susceptibility and environmental influences. The risk is significantly higher in individuals with a positive family history, particularly among first‑degree relatives.¹˒⁵˒¹⁰ Advancing age, especially when accompanied by overweight or obesity, further increases susceptibility. Sedentary lifestyle, high‑calorie diets, smoking, and alcohol consumption have contributed not only to the rising incidence of diabetes but also to associated conditions such as hypertension, dyslipidaemia, coronary heart disease, and the global obesity pandemic.¹˒⁵˒¹⁰˒¹¹
In recent years, the relevance of the ABO blood group system has extended beyond immunohematology. Several studies have linked ABO phenotypes with susceptibility to various infectious and non‑infectious diseases. Blood group O has been associated with increased susceptibility to infections such as cholera, plague, tuberculosis, mumps, and Helicobacter pylori, as well as a higher risk of bleeding due to lower von Willebrand factor levels, while conferring relative protection against malaria. Blood group A has been linked to higher incidences of smallpox, Pseudomonas aeruginosa infections, and malignancies of the stomach, ovaries, salivary glands, cervix, uterus, and colorectum. Blood group B has been associated with gonorrhoea, streptococcal pneumonia, Escherichia coli, and Salmonella infections, whereas blood group AB shows higher incidences of E. coli, Salmonella, smallpox, and cognitive impairment. Gestational diabetes mellitus has also been reported more frequently among women with blood group AB. The relationship between ABO blood groups and metabolic disorders such as diabetes mellitus, hypertension, hyperlipidemia, and ischemic heart disease appears complex and multifactorial. However, emerging evidence suggests a possible association, although further molecular‑level studies are required for definitive conclusions.¹˒¹¹˒¹²˒¹³˒¹⁴˒¹⁵Despite available literature from various countries, Indian data on this topic remain limited, and studies from Kashmir, particularly South Kashmir, are scarce. Existing evidence is often controversial and inconclusive. This lack of regional data and clarity prompted the present study to explore the possible association between ABO blood groups and type 2 diabetes mellitus.
Aims and Objectives
This descriptive cross sectional study was conducted at Government Medical College Anantnag (GMCA) and its associated hospital over a period of six months with effect from January 2019 to June 2019, following approval from the Institutional Ethical and Scientific Committee. A total of 300 confirmed cases of type 2 diabetes mellitus, attending both outpatient and inpatient departments, were included after obtaining informed written consent. Inclusion criteria: Confirmed cases of type 2 diabetes mellitus of either gender, irrespective of age, ethnicity, duration of diabetes, treatment status, or associated comorbidities. Exclusion criteria: Individuals who declined participation, non diabetics, and patients with type 1 diabetes mellitus. Demographic details such as age and gender were recorded, along with history regarding duration of diabetes and associated comorbidities. ABO and Rh blood grouping was performed using the slide (direct) method.
Table 1. Gender Distribution of Study Participants Gender Frequency (n) Percentage (%) Male 139 46.3 Female 161 53.7 Total 300 100 A slight female predominance was observed, although the overall gender distribution was relatively balanced. Table 2. Age Distribution of Study Participants Age Group (Years) Frequency (n) Percentage (%) 1–30 9 3.0 31–60 183 61.0 61–90 108 36.0 Total 300 100 The majority of participants were middle aged, with 61.0% belonging to the 31–60 year age group. Table 3. Incidence of Diabetes Among Different Blood Groups Blood Group Frequency (n) Percentage (%) A+ 71 23.7 A− 4 1.3 B+ 95 31.7 B− 14 4.7 O+ 55 18.3 O− 24 8.0 AB+ 33 11.0 AB− 4 1.3 Total 300 100 Blood group B+ constituted the highest proportion of diabetic patients, followed by A+ and O+. Table 4. Duration of Diabetes Among Participants Duration (Years) Frequency (n) Percentage (%) 0–5 195 65.0 6–10 92 30.7 >10 13 4.3 Total 300 100 Most participants had a relatively short duration of diabetes, with nearly two thirds diagnosed within the previous five years.
In the present study, type 2 diabetes mellitus was more prevalent among individuals with blood group B, while the lowest prevalence was observed among those with blood group O. These findings are consistent with several previously published studies.¹⁶˒¹⁷ Zaidi et al. demonstrated a significant association between T2DM and the ABO blood group system, suggesting possible genetic and immunological links, with increased susceptibility noted among individuals with blood groups B and A.¹⁷ Similarly, Qureshi and Bhatti reported a higher frequency of T2DM in individuals with blood group B and the lowest occurrence in blood group O. Comparable observations were made by Bener and Yousafzai, who found a higher prevalence of blood group B and a lower prevalence of blood group O among diabetic patients.¹⁸ Kamil et al. also reported a greater proportion of T2DM among individuals with blood group B compared with those with blood groups A and O.¹⁹ Stern et al. identified a statistically significant association between T2DM and Rh blood group status (p = 0.0003).²⁰Conversely, some studies have reported conflicting results. Alanazi et al. found no definitive association between ABO blood groups and T2DM.¹⁶ A study from Rawalpindi, Pakistan, reported a lower frequency of blood groups A and B and a higher prevalence of blood group AB among diabetic individuals.²¹ Karagoz et al., while studying gestational diabetes mellitus, observed an increased risk among individuals with blood group AB.²² Fagherazzi et al. suggested that blood group O may be associated with increased susceptibility to endocrine disorders,²³ whereas Okon et al. reported a higher risk of T2DM among individuals with blood group A.²⁴ A study from Muzaffarnagar, India, involving 1,316 participants, demonstrated a stronger association of blood groups AB and O with T2DM.²⁵ Abegaz also emphasized that multiple studies have linked ABO blood groups with metabolic disorders, malignancies, and other non communicable diseases.²⁶ Overall, the literature presents inconsistent evidence regarding the relationship between ABO blood groups and T2DM. These discrepancies may reflect differences in ethnicity, genetic background, and sociodemographic characteristics across study populations.
The present study demonstrates a higher prevalence of type 2 diabetes mellitus among individuals with blood group B. This suggests that blood group B may represent a potential genetic determinant influencing susceptibility to diabetes. Individuals belonging to this higher risk group may benefit from frequent screening for early detection and prevention. Regular awareness programmes focusing on healthy lifestyle practices, including balanced diet, physical activity, weight control, and avoidance of smoking and alcohol, are recommended. Further large scale and molecular level studies across diverse ethnic populations are required to better elucidate the mechanisms underlying this association.
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