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CPE-002 · synthetic case CPE002-FX-021

Metabolic Syndrome without Insulin Measurement

Waist 96 cm, TG 165, HDL 44 and no insulin measurement.

Synthetic · no real patientReviewed acceptance scenarioMetabolic engine v1.0.0

Purpose: Metabolic syndrome criteria are met without any insulin measurement.

Inputs the engine received

Patient

Age
48 years
Waist circumference
96 cm
Systolic bp
126 mmHg
Diastolic bp
78 mmHg

Context

Sex for threshold application
female
Fasting confirmed
Yes
Active medication list available
Yes

Laboratory

Fasting plasma glucose
97 mg/dL
Triglycerides
165 mg/dL
HDL cholesterol
44 mg/dL

What the engine reports

Detected clinical pattern

Metabolic Syndrome Criteria Met

3 of 5 components are met. No Dysglycemia Criterion Identified. Metabolic syndrome does not independently confirm insulin resistance.

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

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 97 mg/dL.
  • Metabolic syndrome criteria met. 3 of 5 components: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL). This does not independently confirm insulin resistance.
  • 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
3.75

Informational only. No threshold interpretation is enabled; it does not diagnose insulin resistance.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Review cardiometabolic risk, including blood pressure, lipids and liver context.Metabolic syndrome criteria met.
  2. 2Review cardiovascular risk.Metabolic syndrome or atherogenic dyslipidemia pattern.

Missing information

  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 14 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 97 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

METS-COMP-001Elevated waist circumference

Inputs: waist 96 cm (female, US (NCEP/AHA) ≥88)

METS_WAIST_COMPONENT_MET

METS-COMP-002Triglycerides ≥150 mg/dL (or treated)

Inputs: triglycerides 165 mg/dL

METS_TRIGLYCERIDES_COMPONENT_MET

METS-COMP-003Low HDL-C (men <40, women <50 mg/dL)

Inputs: HDL-C 44 mg/dL (female)

METS_HDL_COMPONENT_MET

METS-001Metabolic Syndrome Criteria Met

Inputs: Elevated waist circumference · Triglycerides ≥150 mg/dL (or treated) · Low HDL-C (men <40, women <50 mg/dL)

METABOLIC_SYNDROME_CRITERIA_MET

LIPID-001TG to HDL Ratio Informational Calculation

Inputs: TG 165 · HDL-C 44

TG_HDL_RATIO_CALCULATED

LIPID-002Atherogenic Dyslipidemia Supporting Pattern

Inputs: TG 165 ≥150 · HDL-C 44 (low for sex)

ATHEROGENIC_DYSLIPIDEMIA_SUPPORTING_PATTERN

CROSS-CV-001Cardiovascular Risk Review

Inputs: metabolic syndrome criteria met

CARDIOVASCULAR_RISK_REVIEW

IRP-001Metabolic Screening Opportunity

Inputs: Metabolic syndrome criteria met · Atherogenic dyslipidemia supporting pattern

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.
  • 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 components3 of 5

  • ● Waist met
  • ● Triglycerides met
  • ● Low HDL-C met
  • ◌ Blood pressure not met
  • ◌ 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 Syndrome Criteria Met

3 of 5 components are met. No Dysglycemia Criterion Identified. Metabolic syndrome does not independently confirm insulin resistance.

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

Why this pattern was identified

  • No glycemic criterion met. Evaluated: FPG 97 mg/dL.
  • Metabolic syndrome criteria met. 3 of 5 components: Elevated waist circumference; Triglycerides ≥150 mg/dL (or treated); Low HDL-C (men <40, women <50 mg/dL). This does not independently confirm insulin resistance.
  • 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
3.75

Informational only. No threshold interpretation is enabled; it does not diagnose insulin resistance.

Recommended next steps

For physician consideration. Urgent review always comes first.

  1. 1Review cardiometabolic risk, including blood pressure, lipids and liver context.Metabolic syndrome criteria met.
  2. 2Review cardiovascular risk.Metabolic syndrome or atherogenic dyslipidemia pattern.

Missing information

  • Fasting insulin (supporting pattern only; fasting and same-collection glucose required).
Evidence and rule trace · 14 rules

GLY-001No Dysglycemia Criterion Identified

Inputs: FPG 97 mg/dL

NO_GLYCEMIC_CRITERION_FOR_PREDIABETES_OR_DIABETES_IDENTIFIED

METS-COMP-001Elevated waist circumference

Inputs: waist 96 cm (female, US (NCEP/AHA) ≥88)

METS_WAIST_COMPONENT_MET

METS-COMP-002Triglycerides ≥150 mg/dL (or treated)

Inputs: triglycerides 165 mg/dL

METS_TRIGLYCERIDES_COMPONENT_MET

METS-COMP-003Low HDL-C (men <40, women <50 mg/dL)

Inputs: HDL-C 44 mg/dL (female)

METS_HDL_COMPONENT_MET

METS-001Metabolic Syndrome Criteria Met

Inputs: Elevated waist circumference · Triglycerides ≥150 mg/dL (or treated) · Low HDL-C (men <40, women <50 mg/dL)

METABOLIC_SYNDROME_CRITERIA_MET

LIPID-001TG to HDL Ratio Informational Calculation

Inputs: TG 165 · HDL-C 44

TG_HDL_RATIO_CALCULATED

LIPID-002Atherogenic Dyslipidemia Supporting Pattern

Inputs: TG 165 ≥150 · HDL-C 44 (low for sex)

ATHEROGENIC_DYSLIPIDEMIA_SUPPORTING_PATTERN

CROSS-CV-001Cardiovascular Risk Review

Inputs: metabolic syndrome criteria met

CARDIOVASCULAR_RISK_REVIEW

IRP-001Metabolic Screening Opportunity

Inputs: Metabolic syndrome criteria met · Atherogenic dyslipidemia supporting pattern

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.
  • 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.

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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