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Aim The objective of this study was to determine the effectiveness of system-based intervention in reducing the incidence of diabetes and to improve the postnatal metabolic profiles among women with gestational diabetes mellitus (GDM). Materials and methods For women in the intervention arm (n = 130), they received one session of individualized health education at 36 gestational weeks, a booklet of diabetes prevention, five-session of postpartum booster educational program which were conducted including 1 session of dietary and exercise counseling by dietician and physiotherapist at 6 weeks postpartum. For women in the control group (n = 168), standard treatment whereby they had received group therapy on diet and physical activity modification by dietician and staff nurses during the antenatal period. Results There were no significant differences in baseline characteristics between groups for most of the variables examined except for educational level which the control group had a higher education than the intervention group. The women assigned to system-based intervention have a significant difference to GDM women who were assigned to the control group for LDL and HDL but not in anthropometric measurements, blood pressure, glucose index, total cholesterol, and triglyceride. In addition, it was found that the incidence of Type 2 diabetes mellitus (T2DM) 2 years after delivery was 20% in the intervention arm compared to 17% in the control arm. Conclusion The system-based intervention was not statistically superior to the control intervention as there is no difference in terms of incidence of T2DM between the intervention and control group. We, therefore, suggested that more intensive interventions are needed to prevent GDM from developing into T2DM.

Background: In Malaysia, asthma is common but often neglected. Achieving good asthma control and optimal asthma care is a challenge in primary care setting. Aim: To establish an asthma cohort in six public primary care clinics and assess the level of asthma control and care delivered in these clinics. Methods: Children (5-17 years old) and adults (18 years and over) with physician-diagnosed asthma or given asthma treatment in the previous year were recruited. We assessed asthma control, use of spirometry at diagnosis, peak flow monitoring, scheduled reviews, action plan ownership and asthma education as indicators of asthma care. Asthma control was assessed according to GINA global guideline 2017. Results: 1280 patients were recruited; 86% adults and 15% children. Only 37% had good asthma control, 36% were partly controlled and 27% were poorly controlled. Other findings are: 6% had spirometry testing at diagnosis, 71% had scheduled reviews and 61% had a peak flow documented during at least one of the last three visits. Although most (92%) had received some asthma education when asked, only 16% of patients had been given a written asthma action plan. Among those with poorly controlled asthma, only 82% were on an inhaled controller in the last 12 months and 67% were reviewed regularly. Conclusion: Asthma care remains suboptimal and a quality improvement programme in asthma care is needed. Funding: NIHR RESPIRE Global Health Research Unit and is written on behalf of the RESPIRE collaborators.