The c.1246C>G variant in the glucokinase gene, GCK, causes an amino acid change of histidine to aspartic acid at codon 416 (p.His416Asp) of NM_000162.5. This variant is absent from gnomAD v4.1.0 (PM2_Supporting). GCK is defined by the ClinGen MDEP as a gene that has a low rate of benign missense variation and has pathogenic missense variants as a common mechanism of disease (PP2). This variant is predicted to be deleterious by computational evidence, with a REVEL score of 0.971, which is greater than the MDEP VCEP threshold of 0.70 (PP3). The variant resides in an amino acid that directly binds ATP, which is defined as critical for the protein’s function by the ClinGen MDEP (PM1). Another missense variant at the same residue, c.1247A>G (p.His416Arg), has been classified as pathogenic by the ClinGen MDEP and p.His416Asp has a greater Grantham distance (PM5). This variant was identified in two unrelated individuals with hyperglycemia; however, PS4_Moderate cannot be applied because this number is below the ClinGen MDEP threshold and PP4 cannot be applied due to insufficient clinical information (internal lab contributors). In summary, c.1246C>G meets the criteria to be classified as likely pathogenic for monogenic diabetes. ACMG/AMP criteria applied, as specified by the ClinGen MDEP (specification version 3.1.0, approved 10/10/2025): PP2, PP3, PM1, PM2_Supporting, PM5.