The c.1265_1273delinsTGCGAGCCACCTTCAT variant in the glucokinase gene, GCK, causes a frameshift in the protein at codon 422 (NM_000162.5), adding 39 novel amino acids before encountering a stop codon (p.(Arg422LeufsTer39)). While this variant, located in exon 10 of 10, is predicted to cause a premature stop codon and to escape nonsense mediated decay, it is in a functionally important region of a gene where loss-of-function is an established disease mechanism (PVS1). This variant is absent in gnomAD v2.1.1 (PM2_Supporting). This variant was identified in an individual with diabetes; however, PP4 is unable to be evaluated due to insufficient clinical information (internal lab contributors). In summary, c.1265_1273delinsTGCGAGCCACCTTCAT meets the criteria to be classified as likely pathogenic for monogenic diabetes. ACMG/AMP criteria applied, as specified by the ClinGen MDEP (specification version 1.2.0 approved 6/7/2023): PVS1, PM2_supporting.