When the Scientific Sessions convened in San Francisco in 2014, new diabetes research and technology was on the cusp of several breakthroughs.

The 74th Scientific Sessions brought together more than 17,300 attendees from 121 countries. More than 2,000 abstracts were featured as poster presentations and 771 speakers addressed attendees at 96 symposia. San Francisco itself went through a few major events that year, including the death of beloved hometown actor Robin Williams and the Giants World Series championship over the Kansas City Royals.

Here are some of the highlights from the 74th Scientific Sessions in San Francisco:

Trial Results

Researchers presented results from the Outcome Reduction With Initial Glargine Intervention (ORIGIN) trial. Post hoc analyses of major glycemic control trials around the world suggested that tighter glycemic control was associated with increased incidence of hypoglycemia. But it was still unclear whether the increase in hypoglycemia stemming from tighter glycemic control increased cardiovascular events.

Two other trials, Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Veterans Affairs Diabetes Trial (VADT), suggested that tighter glucose control is likely to induce more frequent episodes of hypoglycemia compared to less strict regimens.

The VADT study, explained by Peter D. Reaven, MD, showed non-Hispanic whites had more episodes of hypoglycemia compared to non-Hispanic blacks and Hispanics in the VA study.

Researchers also presented 11-year follow-up results of the Diabetes Prevention Program Outcomes Study (DPPOS), showing lifestyle intervention or metformin significantly reduced type 2 diabetes development over 15 years.

Guideline Controversy

The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults was still controversial in 2014. At the 74th Scientific Sessions, experts debated the pros and cons of the guideline, which identified approximately 13 million Americans as newly eligible to be considered for statin therapy.

Artificial Pancreas

Results of the first randomized crossover trial of the safety of a wearable artificial pancreas were presented at the 74th Scientific Sessions and showed that closed-loop control of diabetes reduced the number of hypoglycemic episodes as measured by a low blood glucose index and no significant adverse events, said Boris P. Kovatchev, PhD. In 2016, the U.S. Food and Drug Administration approved the first hybrid closed-loop system, the Medtronic MiniMed 670G.

Award Lectures and Presidents’ Addresses

Daniel J. Drucker, MD, received the Banting Medal for Scientific Achievement Award in 2014. In his lecture, Deciphering Metabolic Messages from the Gut Drives Therapeutic Innovation, he described three decades of work on the glucagon gene.

Although the number of people with diabetes soared to 9 percent of the U.S. population in 2014, funding for research and other initiatives to stop diabetes was on the decline. ADA President, Medicine & Science, Elizabeth R. Seaquist, MD, called upon meeting attendees to help advance ADA’s mission of preventing and curing diabetes, and improving the lives of people affected by the disease. “We need a transformational change in how we approach this disease if we are really going to achieve the mission of ADA,” she said.

Katie Weinger, EdD, RN, FAADE, explored the impact of diabetes education on self-management during her Outstanding Educator in Diabetes Award Lecture, Six Impossible Things Before Breakfast—Examining Diabetes Self-Care.

ADA President, Health Care & Education, Marjorie Cypress, PhD, C-ANP, CDE, called for more activism from healthcare professionals in the battle against the diabetes epidemic.

Other Award Lectures

Joel K. Elmquist, DVM, PhD, received the Outstanding Scientific Achievement Award in 2014 for research that helped shape our understanding of central regulation of energy homeostasis.

William H. Polonsky, PhD, CDE, presented the Richard R. Rubin Award Lecture, Changing the Conversations in Behavioral Diabetes—Important Lessons My Patients Have Taught Me. “Targeting behavior change is a mistake,” Dr. Polonsky said at the time. “Instead of focusing on behavioral change, we need to focus on worthwhileness. If we can’t help and support our patients to believe that it is worthwhile to actively manage their disease, nothing will ever change.”

During the Kelly West Award for Outstanding Achievement in Epidemiology Lecture, Andrzej S. Krolewski, MD, PhD, challenged the widely held belief that microalbuminuria, or minute amounts of a certain protein in the urine, is the first step on the path to end-stage renal disease. His research indicated that end-stage renal disease begins with early, progressive renal decline, a process independent of microalbuminuria that starts while patients have normal renal function.

Jacob E. Friedman, PhD, presented the Norbert Freinkel Award Lecture and described his novel research to define cellular changes during pregnancy in women with obesity and gestational diabetes. The data he presented suggested that a gut microbiome derived from an obese mother may provide a foundation to understand her metabolism, as well as the contribution of maternally inherited obesity in the next generation.

William J. Jeffcoate, MRCP, said multidisciplinary care is needed to combat the chronic nature of the diabetic foot during the annual Roger Pecoraro Award Lecture. Foot wounds may become refractory because of unspecified defects in cells and tissues caused by the abnormalities of small-vessel function that are commonplace in diabetes, he said.

During the Edwin Bierman Award Lecture, Kari E. Bornfeldt, PhD, described her research into the mechanisms of cardiovascular complications of diabetes, and specifically diabetes-accelerated atherosclerosis.