Synthetic data only. Never enter patient information; nothing is sent or stored. For clinicians. Not FDA cleared.For licensed clinicians. Educational demonstration on synthetic data. Never enter real patient identifiers or protected health information: everything runs in your browser and nothing is sent or stored. Clinical decision support only; not FDA cleared; physician review is required.
CPE-002 · synthetic case CPE002-FX-007
Hyperinsulinemic Pattern with Normal Glycemic Tests
Normal glucose and HbA1c, fasting insulin 22 µIU/mL, TG 170, HDL 42.
Purpose: Hyperinsulinemic pattern with normal glycemic tests: sandbox-only candidate.
Inputs the engine received
Patient
- Age
- 44 years
Context
- Sex for threshold application
- female
- Fasting confirmed
- Yes
- Active medication list available
- Yes
- Same collection episode for glucose and insulin
- Yes
Laboratory
- Fasting plasma glucose
- 92 mg/dL
- Hemoglobin a1c
- 5.3 %
- Fasting insulin
- 22 µIU/mL
- Triglycerides
- 170 mg/dL
- HDL cholesterol
- 42 mg/dL
What the engine reports
Detected clinical pattern
Metabolic Screening Opportunity Identified
Risk context is present (Atherogenic dyslipidemia supporting pattern). 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 92 mg/dL; HbA1c 5.3%.
- Atherogenic dyslipidemia supporting pattern. High triglycerides with low HDL-C. Supports metabolic risk context; it does not diagnose insulin resistance.
- Metabolic screening opportunity. Risk context identified; insulin resistance is not diagnosed.
Calculations
- TG/HDL-C ratio
- 4.05
- HOMA-IR
- 5
Informational only. No threshold interpretation is enabled; it does not diagnose insulin resistance.
Calculation only. Production interpretation is disabled: no validated threshold profile exists yet.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Review cardiovascular risk.Metabolic syndrome or atherogenic dyslipidemia pattern.
Missing information
- Metabolic syndrome components not entered: Elevated waist circumference; BP ≥130/85 mmHg (or treated).
Evidence and rule trace · 12 rules
GLY-001No Dysglycemia Criterion Identified
Inputs: FPG 92 mg/dL · HbA1c 5.3%
NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED
METS-COMP-002Triglycerides ≥150 mg/dL (or treated)
Inputs: triglycerides 170 mg/dL
METS_TRIGLYCERIDES_COMPONENT_MET
METS-COMP-003Low HDL-C (men <40, women <50 mg/dL)
Inputs: HDL-C 42 mg/dL (female)
METS_HDL_COMPONENT_MET
MISS-002Metabolic Syndrome Incomplete Data
Inputs: 2 of 5 components met · missing: Elevated waist circumference; BP ≥130/85 mmHg (or treated)
METABOLIC_SYNDROME_ASSESSMENT_INCOMPLETE
LIPID-002Atherogenic Dyslipidemia Supporting Pattern
Inputs: TG 170 ≥150 · HDL-C 42 (low for sex)
ATHEROGENIC_DYSLIPIDEMIA_SUPPORTING_PATTERN
CROSS-CV-001Cardiovascular Risk Review
Inputs: atherogenic dyslipidemia supporting pattern
CARDIOVASCULAR_RISK_REVIEW
IRP-001Metabolic Screening Opportunity
Inputs: Atherogenic dyslipidemia supporting pattern
METABOLIC_SCREENING_OPPORTUNITY_IDENTIFIED
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.
- EV-METS-2009 · IDF/AHA/NHLBI/WHF/IAS/IASO Joint Interim Statement. Harmonizing the Metabolic Syndrome. Circulation. 2009;120:1640-1645.
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 components2 of 5
- ○ Waist not entered
- ● Triglycerides met
- ● Low HDL-C met
- ○ 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
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.
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.
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