He answered the prevention intake. What should we test?

MVMarkus Vogel, 44 · Prevention programme, results of 15 September: prediabetes, lipids above goal, vitamin D low · 6 documents, read 16 September 2026

Answered on 16 September 2026

Patient record6 documents, updated 16 September 2026

Markus Vogel, 44, IT project lead, new to the practice. 181 cm, 94 kg, BMI 28.7, waist 101 cm. Never smoked. Two glasses of wine most evenings. Moves for twenty minutes on one day a week. Sleeps six hours, snores. Intake 10.09.2026
Father: type 2 diabetes at 55. Mother: hypertension. Grandfather: stroke at 70. No cardiovascular event before 55 in the family. Intake 10.09.2026
No diagnoses, no regular medication, ibuprofen a few times a month for headaches, magnesium as a supplement. Last blood test March 2019 at an occupational check: total cholesterol 214 mg/dl, glucose 96, ALT 39. Intake 10.09.2026 Lab 03.2019
Tired most afternoons since the spring. Wants to know “where I stand” and asked for “the blood panel my colleagues did”. Intake 10.09.2026

The intake gives the panel its shape. Three things in it decide what is worth measuring: a father with type 2 diabetes at 55 and a waist of 101 cm, which put him in the group where prediabetes is found early; the alcohol and the ALT of 39 in 2019, which make the liver worth a proper look; and a cardiovascular risk that cannot be estimated yet, because no lipid has been measured in seven years. Intake 10.09.2026 Lab 03.2019 Diabetes Care Eur Heart J

I would order 34 markers in eight groups. Each one either feeds the risk estimate, answers a question the intake raised, or is measured once in a lifetime:

Heart and lipids: total, LDL, HDL and non-HDL cholesterol, triglycerides, apolipoprotein B, lipoprotein(a). SCORE2 needs the non-HDL; the ESC/EAS guideline sets the goals on LDL and apolipoprotein B; lipoprotein(a) is recommended once in every adult. Eur Heart J + 2
Sugar and metabolism: fasting glucose, HbA1c, fasting insulin with HOMA-IR, uric acid. The ADA criteria for prediabetes rest on HbA1c and fasting glucose; with his family history both belong in the baseline. Diabetes Care Diabetologia
Liver: ALT, AST, GGT, alkaline phosphatase, bilirubin, albumin, and FIB-4 computed from ALT, AST, age and platelets. The EASL guideline asks for FIB-4 in anyone with metabolic risk, and his 2019 ALT was already at the upper edge. J Hepatol Am J Gastroenterol
Kidney: creatinine with eGFR, urine albumin-to-creatinine ratio. KDIGO staging needs both. Kidney Int
Thyroid: TSH and free T4, because tiredness is in the intake. Thyroid
Iron and vitamins: ferritin, transferrin saturation, 25-hydroxyvitamin D, vitamin B12, folate. Tiredness again, and vitamin D deficiency is common enough in Hamburg in September to measure rather than guess. WHO J Clin Endocrinol Metab
Inflammation: high-sensitivity CRP, as a risk modifier. Circulation
Blood count: haemoglobin, leukocytes, platelets, MCV. Platelets are needed for FIB-4.

Not ordered, and why. Testosterone, cortisol, omega-3 index, zinc, magnesium and a “biological age” are on the commercial panels he mentioned; none of them changes a decision for a 44-year-old without symptoms, and no guideline asks for them. PSA is not recommended at 44 without a family history. If he wants them anyway, they are a separate conversation with a separate price. Eur Heart J AWMF

The order is drafted below. The lipids, glucose and urine are covered by the statutory check-up; the rest he pays for, and the laboratory invoices him directly. The cost sheet for him is the next step. G-BA medas

Lab orderDraft, for your signature

Prevention panel, 34 markers

Eight groups, each with the reason it is measured
Six markers covered by the check-up, 28 self-paid
Goes to the laboratory as an order, with the private form

A draft until you sign it, and it reaches the patient under your name

From the patient record2 of 6 documents

Prevention intake, answered in the app, 10 September 2026Anamnesis
Occupational health check, uploaded by the patient, March 2019Laboratory

1.2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026.Diabetes Care. 2026;49(Suppl 1):S27-S49. American Diabetes Association Professional Practice Committee.Guideline
SummaryPrediabetes is defined by an HbA1c of 5.7 to 6.4 %, fasting glucose of 100 to 125 mg/dl or a 2-hour glucose of 140 to 199 mg/dl; diabetes from 6.5 % HbA1c, 126 mg/dl fasting or 200 mg/dl at 2 hours. People with prediabetes should be re-tested at least yearly and referred to structured lifestyle programmes.
Source
Issuing body: American Diabetes Association
Published: January 2026, updated annually
Grading system: ADA evidence grades A–E
Scope
Target population: Adults and children at risk of or with diabetes
Scope: Diagnostic criteria, screening intervals, classification
2.2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.European Heart Journal. 2021;42:3227-3337. Visseren FLJ, Mach F, Smulders YM, et al.Guideline
SummaryRisk estimation with SCORE2 for apparently healthy people aged 40 to 69; below 50 years, under 2.5 % is low, 2.5 to below 7.5 % moderate, 7.5 % and above high risk. Risk modifiers include a family history of premature cardiovascular disease, lipoprotein(a) and coronary artery calcium. In moderate-risk people, lipid-lowering treatment should be considered when LDL cholesterol stays at or above 2.6 mmol/l (100 mg/dl) after lifestyle intervention. At least 150 minutes of moderate activity a week; alcohol limited to 100 g a week.
Source
Issuing body: European Society of Cardiology
Published: September 2021
Grading system: ESC classes of recommendation I–III, levels of evidence A–C
Scope
Target population: Apparently healthy people and patients with established disease
Scope: Risk assessment, lifestyle, lipids, blood pressure, diabetes
3.2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.European Heart Journal. 2020;41:111-188. Mach F, Baigent C, Catapano AL, et al.Guideline
SummaryLDL cholesterol goals by risk category: below 116 mg/dl at low risk, below 100 mg/dl at moderate risk, below 70 mg/dl at high risk, below 55 mg/dl at very high risk; the corresponding apolipoprotein B goals are 100, 80 and 65 mg/dl. Triglycerides carry no goal; below 150 mg/dl indicates lower risk. Lipoprotein(a) should be measured at least once in every adult.
Source
Issuing body: ESC and European Atherosclerosis Society
Published: January 2020
Grading system: ESC classes of recommendation I–III, levels of evidence A–C
Scope
Target population: Adults with dyslipidaemia or elevated cardiovascular risk
Scope: Targets, drugs, monitoring
4.Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement.European Heart Journal. 2022;43:3925-3946. Kronenberg F, Mora S, Stroes ESG, et al.Guideline
SummaryLipoprotein(a) is genetically determined and stable over life; one measurement is enough. Below 75 nmol/l (30 mg/dl) rules out a relevant contribution to risk, 75 to 125 nmol/l (30 to 50 mg/dl) is a grey zone, 125 nmol/l (50 mg/dl) and above increases risk. There is no approved drug that lowers it; the consequence is stricter control of the other risk factors.
Source
Issuing body: European Atherosclerosis Society
Published: October 2022
Grading system: Consensus statement
Scope
Target population: All adults, once
Scope: Measurement, thresholds, consequences
5.SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe.European Heart Journal. 2021;42:2439-2454. SCORE2 working group and ESC Cardiovascular risk collaboration.Trial
6.Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.Diabetologia. 1985;28:412-419. Matthews DR, Hosker JP, Rudenski AS, et al.Trial
7.EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).Journal of Hepatology. 2024;81:492-542. European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity.Guideline
SummarySteatotic liver disease with at least one cardiometabolic risk factor is MASLD. In primary care, patients with steatosis or metabolic risk should have non-invasive fibrosis assessment with FIB-4: below 1.3 rules out advanced fibrosis with repeat testing in one to three years; 1.3 or above calls for elastography or referral. Treatment is weight reduction, physical activity and control of the metabolic risk factors.
Source
Issuing body: EASL, EASD, EASO
Published: September 2024
Grading system: GRADE
Scope
Target population: Adults with steatotic liver disease and metabolic risk factors
Scope: Case finding, fibrosis assessment, management
8.ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries.American Journal of Gastroenterology. 2017;112:18-35. Kwo PY, Cohen SM, Lim JK.Guideline
9.KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.Kidney International. 2024;105(4S):S117-S314. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group.Guideline
10.Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association.Thyroid. 2012;22:1200-1235. Garber JR, Cobin RH, Gharib H, et al.Guideline
11.WHO guideline on use of ferritin concentrations to assess iron status in individuals and populations.World Health Organization. 2020. World Health Organization.Guideline
12.Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism. 2011;96:1911-1930. Holick MF, Binkley NC, Bischoff-Ferrari HA, et al.Guideline
SummaryDeficiency is a 25-hydroxyvitamin D below 20 ng/ml (50 nmol/l), insufficiency 21 to 29 ng/ml. Adults with deficiency are treated with vitamin D2 or D3, then kept on a maintenance dose of 1,500 to 2,000 IU a day; re-testing after about three months.
Source
Issuing body: Endocrine Society
Published: July 2011
Grading system: GRADE
Scope
Target population: Adults and children at risk of deficiency
Scope: Thresholds, treatment, prevention
13.Markers of inflammation and cardiovascular disease: application to clinical and public health practice. A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association.Circulation. 2003;107:499-511. Pearson TA, Mensah GA, Alexander RW, et al.Guideline
14.S3-Leitlinie Hausärztliche Risikoberatung zur kardiovaskulären Prävention (AWMF-Registernummer 053-024).Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin. Current version. Guideline
15.Richtlinie über die Gesundheitsuntersuchungen zur Früherkennung von Krankheiten (Gesundheitsuntersuchungs-Richtlinie).Gemeinsamer Bundesausschuss. Current version. Programme
16.Kapitel M GOÄ: Wer darf welche Laborleistungen liquidieren.medas Abrechnungsgesellschaft. Current version. Programme

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Markus Vogel, 44Mosaic