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-010
Treated State with Metformin and GLP-1
Prediabetes labs in a patient on metformin and a GLP-1 agonist.
Purpose: Treated metabolic state modifies interpretation.
Inputs the engine received
Patient
- Age
- 50 years
Context
- Sex for threshold application
- female
- Fasting confirmed
- Yes
- Active medication list available
- Yes
- Metformin active
- Yes
- GLP-1 RA active
- Yes
- Glucose lowering medication active
- Yes
Laboratory
- Fasting plasma glucose
- 118 mg/dL
- Hemoglobin a1c
- 6.1 %
What the engine reports
Detected clinical pattern
Prediabetes Criteria Met
At least one guideline prediabetes criterion is met.
- Glycemic: Prediabetes Criteria Met
- Validity: Interpretation modified by context
- Metabolic syndrome: Metabolic syndrome: incomplete assessment
- IR-associated pattern: IR-associated pattern: not assessable
Why this pattern was identified
- Glycemic criteria met. FPG 100–125 mg/dL; HbA1c 5.7–6.4%.
Recommended next steps
For physician consideration. Urgent review always comes first.
- 1Review prediabetes criteria and the patient's risk profile per current standards of care.Guideline criterion met (ADA).
- 2Interpret with the listed validity modifiers in mind.treated metabolic state present
Differentials, pitfalls and contradicting signals
- Treated metabolic state: glucose, insulin and lipid values may be modified by therapy.
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 · 10 rules
VALIDITY-003Treated Metabolic State
Inputs: metformin · GLP-1 RA · glucose-lowering medication
TREATED_METABOLIC_STATE_PRESENT
METS-COMP-005Fasting glucose ≥100 mg/dL (or treated)
Inputs: on glucose-lowering medication
METS_GLUCOSE_COMPONENT_MET
MISS-002Metabolic Syndrome Incomplete Data
Inputs: 1 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
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-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 components1 of 5
- ○ Waist not entered
- ○ Triglycerides not entered
- ○ Low HDL-C not entered
- ○ Blood pressure not entered
- ● Fasting glucose 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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