[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-433728-105":59,"doc-detail-433728-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","incretin-integration-charting-the-future-of-cardiovascular-kidney-metabolic-health","Incretin integration - Charting the future of cardiovascular-kidney-metabolic health","","Editorial analysis of the therapeutic shift in type 2 diabetes from glucose-centric targets toward organ-protective cardiovascular-kidney-metabolic (CKM) care. It highlights lessons from major trials despite glucose lowering, then explains how incretin-based therapies—especially GLP-1 receptor agonists and GIP/GLP-1 dual agonists such as tirzepatide—provide cardiovascular and renal benefits beyond glycemic control. The piece discusses biologic mechanisms, CKM syndrome concepts, study limitations, and the need for long-term safety monitoring, with future focus on steatotic liver disease and dementia.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/incretin-integration-charting-the-future-of-cardiovascular-kidney-metabolic-health/433728/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/incretin-integration-charting-the-future-of-cardiovascular-kidney-metabolic-health/433728.png","ImageObject",300,407,{"name":92,"@type":93},"Ivy","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why did diabetes management shift away from HbA1c as the dominant goal?","Question",{"text":113,"@type":114},"Trials such as ACCORD, ADVANCE, and VADT showed that intensive glucose control did not deliver macrovascular benefits, prompting a need for more nuanced, organ-focused therapy.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What benefits do incretin-based therapies provide beyond glucose lowering?",{"text":118,"@type":114},"The text notes cardiovascular and renal benefits independent of glycemic efficacy, alongside effects on appetite and satiety, ectopic fat metabolism, systemic inflammation, oxidative stress, and direct organ protection.",{"name":120,"@type":111,"acceptedAnswer":121},"What concerns temper overly optimistic interpretation of CKM-related evidence?",{"text":122,"@type":114},"The editorial emphasizes caution due to potential variability in trial design, limited generalizability from selected populations, incomplete understanding of mechanisms, and concerns about gastrointestinal side effects and long-term tolerability.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},433728,1790957897,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":24,"preview_page_count":4},549758252649,"https://ap-avatar.wpscdn.com/avatar/8000253669c5317157?_k=1778319167496531819","J Chin MedAssoc  \nEditorial  \nIncretin integration: Charting the future of cardiovascular-kidney-metabolic health  \nChih-Yuan Wang*  \nDivision of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC  \nHistorically, type 2 diabetes mellitus (T2DM) management revolved around glycemic control, with hemoglobin A1c (HbA1c) reduction being the dominant target. However, the sobering lessons of trials such as ACCORD (Action to Control Cardiovascular Risk in Diabetes),1 ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation),2 and VADT (Veterans Affairs Diabetes Trial),3 which failed to demonstrate macrovascular benefits despite statistically significant glucose control, necessitated a subtle and more nuanced therapeutic intervention.4 However, we now are witnessing a paradigm shift from contemporarily cardiometabolic medicine in the past decade. The core transformation was based on the incretin-based therapy, especially glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and glucose-dependent insulinotropic polypeptide (GIP)/ GLP-1 RA dual agonists, like tirzepatide.5 Chiang et al6 present a comprehensive review and timely synthesis of the flourishing evidences, and point out the positions of incretin-based therapies as cornerstones of cardiovascular-kidney-metabolic (CKM) health. Recent observations in clinical research do not mark just a progression in diabetes treatment, but a fundamental shift of approach to disease management across various target-organ systems.7 Initially, incretin-based therapies were first recognized for their advantage in lowering blood glucose without hypoglycemia,8 however, they have further demonstrated significant cardiovascular and renal benefits, well beyond glycemic control. This evidence marks an important turning point for diabetes care, guiding clinicians to focus on protecting vital organs as well as concentrating only on blood glucose control.9 Incretin-based therapies, due to their wide-ranging biological actions, are well suited to address the complex interplay of metabolic and cardiovascular disorders. GLP-1 RAs provide benefits in heart and kidney independent of their efficacy on glucose control. The other pharmacologic effects of GLP-1 RAs include regulating appetite and satiety in the central nervous system, improving ectopic fat metabolism and accumulation in liver, reducing systemic inflammation and oxidative stress, as well as exerting direct protective effects on the heart and kidneys. GLP-1 RAs, including semaglutide, dulaglutide, and liraglutide, have demonstrated a wide  \n*Address correspondence. Dr. Chih-Yuan Wang, Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, 7, Chung-Shan South Road, Taipei 100, Taiwan, ROC. E-mail address:  \n[cyw1965@gmail.com](cyw1965@gmail.com); [cyw1965@ntu.edu.tw](cyw1965@ntu.edu.tw) (C.-Y. Wang).  \nConflicts of interest: The author declares that he/she has no conflicts of interest related to the subject matter or materials discussed in this article.  \nJournal of Chinese Medical Association. (2025) 88: 728-729.  \nReceived July 27, 2025; accepted July 30, 2025. doi: 10. 1097/JCMA.0000000000001277  \nCopyright © 2025, the Chinese Medical Association. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/](http://creativecommons.org/licenses/)[ ](http://creativecommons.org/licenses/)[by-nc-nd/4.0/](by-nc-nd/4.0/))  \nrange of clinical benefits, including decreasing the risk of major cardiovascular events, slowing the progression of chronic kidney disease (CKD), reducing all-cause mortality. In addition, further studies in GLP-1 RAs even support weight loss along with improvements in other metabolic risk factors.10  \nIt cannot be ignored that the era of reframing the therapeutic strategies of CKM syndrome is coming. The introduction ","cbCaiiRF8RHwGONk","https://ap.wps.com/l/cbCaiiRF8RHwGONk","pdf",261291,"English","# Editorial\n## Incretin-based paradigm shift\n## CKM syndrome framework and clinical implications\n## Evidence considerations and future directions","[{\"question\":\"Why did diabetes management shift away from HbA1c as the dominant goal?\",\"answer\":\"Trials such as ACCORD, ADVANCE, and VADT showed that intensive glucose control did not deliver macrovascular benefits, prompting a need for more nuanced, organ-focused therapy.\"},{\"question\":\"What benefits do incretin-based therapies provide beyond glucose lowering?\",\"answer\":\"The text notes cardiovascular and renal benefits independent of glycemic efficacy, alongside effects on appetite and satiety, ectopic fat metabolism, systemic inflammation, oxidative stress, and direct organ protection.\"},{\"question\":\"What concerns temper overly optimistic interpretation of CKM-related evidence?\",\"answer\":\"The editorial emphasizes caution due to potential variability in trial design, limited generalizability from selected populations, incomplete understanding of mechanisms, and concerns about gastrointestinal side effects and long-term tolerability.\"}]","Incretin integration - Charting the future of cardiovascular-kidney-metabolic health | PDF",1790665301]