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CPE-002 · synthetic case CPE002-EX-03

Family history, prior gestational diabetes and PCOS with normal glucose

Normal fasting glucose, but three high-risk modifiers.

Synthetic · no real patientExtended demonstration caseMetabolic engine v1.0.0

Purpose: Normal fasting glucose, but three high-risk modifiers.

Inputs the engine received

Patient

Age
33 years

Context

Sex for threshold application
female
Fasting confirmed
Yes
Active medication list available
Yes
First degree family history T2D
Yes
History of gestational diabetes
Yes
PCOS documented
Yes

Laboratory

Fasting plasma glucose
91 mg/dL

What the engine reports

Detected clinical pattern

Metabolic Screening Opportunity Identified

Risk context is present (First-degree family history of T2D; Prior gestational diabetes; PCOS documented). Insulin resistance is not diagnosed. No Dysglycemia Criterion Identified.

  • Glycemic: No Dysglycemia Criterion Identified
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: Metabolic screening opportunity

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 91 mg/dL.
  • Metabolic screening opportunity. Risk context identified; insulin resistance is not diagnosed.

Differentials, pitfalls and contradicting signals

  • First-degree family history of type 2 diabetes.
  • Prior gestational diabetes (high-risk modifier).
  • PCOS documented.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 11 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 91 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

CLIN-002Family History Modifier

Inputs: first-degree family history of T2D

FIRST_DEGREE_T2D_FAMILY_HISTORY_PRESENT

CLIN-003Prior Gestational Diabetes Modifier

Inputs: history of gestational diabetes · not currently pregnant

PRIOR_GESTATIONAL_DIABETES_HIGH_RISK_MODIFIER

CLIN-004PCOS Modifier

Inputs: PCOS documented

PCOS_METABOLIC_RISK_MODIFIER_PRESENT

IRP-001Metabolic Screening Opportunity

Inputs: First-degree family history of T2D · Prior gestational diabetes · PCOS documented

METABOLIC_SCREENING_OPPORTUNITY_IDENTIFIED

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

Evidence

  • EV-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.
  • EV-NIDDK-IR · National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance & Prediabetes.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

Change the values

The same engine, starting from this case. Change any value and watch the pattern and the rule trace react.

Glycemic testsDrag the sliders to cross a threshold
  • <100
  • 100–125 prediabetes
  • ≥126 diabetes range
  • <5.7
  • 5.7–6.4 prediabetes
  • ≥6.5 diabetes range

75-g protocol

Lipids, body and blood pressure
  • <150
  • 150–499
  • ≥500 priority
  • ≥1000 urgent

Metabolic syndrome components0 of 5

  • ○ Waist not entered
  • ○ Triglycerides not entered
  • ○ Low HDL-C not entered
  • ○ Blood pressure not entered
  • ◌ Fasting glucose not met

● met · ◌ not met · ○ not entered. Three or more meet the criteria; that does not confirm insulin resistance.

Patient and scope
Sex for thresholds
Ketones
Symptoms and safety
Risk context
Liver context
Medications
Outside the standard adult runtime
Fasting insulin (supporting only)Calculation and sandbox

Shown with HOMA-IR when fasting and same-collection are confirmed. It does not classify anything.

Research sandbox (unvalidated)

In production the insulin and HOMA-IR rules are off: no validated threshold profile exists. Here you can supply your own threshold to see how the sandbox rules would behave. The output is labeled a sandbox candidate and is never a diagnosis.

Live result · computed in your browser

Detected clinical pattern

Metabolic Screening Opportunity Identified

Risk context is present (First-degree family history of T2D; Prior gestational diabetes; PCOS documented). Insulin resistance is not diagnosed. No Dysglycemia Criterion Identified.

  • Glycemic: No Dysglycemia Criterion Identified
  • Validity: Interpretation valid
  • Metabolic syndrome: Metabolic syndrome: incomplete assessment
  • IR-associated pattern: Metabolic screening opportunity

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 91 mg/dL.
  • Metabolic screening opportunity. Risk context identified; insulin resistance is not diagnosed.

Differentials, pitfalls and contradicting signals

  • First-degree family history of type 2 diabetes.
  • Prior gestational diabetes (high-risk modifier).
  • PCOS documented.

Missing information

  • Metabolic syndrome components not entered: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated).
  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 11 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 91 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

MISS-002Metabolic Syndrome Incomplete Data

Inputs: 0 of 5 components met · missing: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL); BP ≥130/85 mmHg (or treated)

METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE

CLIN-002Family History Modifier

Inputs: first-degree family history of T2D

FIRST_DEGREE_T2D_FAMILY_HISTORY_PRESENT

CLIN-003Prior Gestational Diabetes Modifier

Inputs: history of gestational diabetes · not currently pregnant

PRIOR_GESTATIONAL_DIABETES_HIGH_RISK_MODIFIER

CLIN-004PCOS Modifier

Inputs: PCOS documented

PCOS_METABOLIC_RISK_MODIFIER_PRESENT

IRP-001Metabolic Screening Opportunity

Inputs: First-degree family history of T2D · Prior gestational diabetes · PCOS documented

METABOLIC_SCREENING_OPPORTUNITY_IDENTIFIED

MISS-001Insulin Pattern Missing Data

Inputs: fasting insulin not provided

IR_PATTERN_NOT_FULLY_ASSESSABLE_WITH_CURRENT_DATA

IRP-002Hyperinsulinemic Supporting Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-003Elevated HOMA-IR Supporting Findingsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

IRP-004Convergent IR-Associated Patternsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

TREND-MET-001Composite Metabolic Deterioration Warningsandbox · off

Sandbox rule — disabled by default. Needs an assay-specific threshold profile and external endocrinology validation.

Evidence

  • EV-ADA-2026-DIAG · American Diabetes Association Professional Practice Committee for Diabetes. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S27-S49.
  • EV-NIDDK-IR · National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance & Prediabetes.

Physician adjudication required. Clinical decision support only. This output identifies guideline-based glycemic and metabolic findings and risk context. It does not diagnose insulin resistance, select treatment or recommend medication. Physician adjudication is required.

More metabolic cases

CPE002-FX-001

Healthy Metabolic Baseline

A 35-year-old with normal glucose, lipids, waist and blood pressure.

CPE002-FX-002

Prediabetes by HbA1c

HbA1c of 6.0% and nothing else.

CPE002-FX-003

Prediabetes by FPG

Confirmed-fasting glucose of 108 mg/dL.

CPE002-FX-004

OGTT-Only Prediabetes

Only a 75-g OGTT: 2-hour glucose 165 mg/dL.

CPE002-FX-005

Diabetes-Range Finding

HbA1c 6.8% and fasting glucose 134 mg/dL.

CPE002-FX-006

Metabolic Syndrome with Normal Glucose

Normal glucose, but waist 108 cm, TG 190, HDL 36 and BP 138/88.

All metabolic cases

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