10-year-old Nebraska boy gets drug to delay Type 1 diabetes


Like a lot of boys his age, Richard Gehring likes building forts and playing sports, especially football.

In February, the 10-year-old from Columbus, Nebraska, received a new therapy that his parents and his caregivers hope will buy him more time to run and play without the everyday struggles that come with managing Type 1 diabetes.

While it’s not considered a cure, studies show that the therapy, which goes by the name brand TZIELD, can delay the onset of Type 1 diabetes for about three years in people at high risk of developing the condition. Richard was the first patient to receive the treatment at Children’s Nebraska and is believed to be the first youngster in Nebraska to undergo it.

The Food and Drug Administration approved the therapy for people 8 and older in late 2022. Richard became eligible for the treatment in January, when tests indicated that he was in Stage 2 — of three total stages — of Type 1 diabetes. Joanna Gehring, his mother, said they knew at that point that he likely would progress to the final stage within a year, or maybe a little longer.

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The Gehring family, with four members with Type 1 diabetes already, is well aware of what that can mean. Seth Gehring, Richard’s father, was diagnosed with Type 1 diabetes at age 11. Richard’s two older brothers, now teenagers, were diagnosed as toddlers. The youngest of the family’s five boys, who will soon turn 3, was diagnosed at 14 months. Joanna Gehring’s grandfather had Type 2 diabetes but eventually required insulin and suffered diabetes-related health complications.

“In our minds, the longer you can put off diabetes, especially Type 1, the better chance of a better outcome later in their lives,” she said.







Richard Gehring 2

Richard Gehring, second from left, recently received a therapy that can delay onset of Type 1 diabetes. With him are, from left, his father, Seth Gehring; Katie Decker, manager of specialty clinics at Children’s Nebraska; and Dr. Salaheddin Elrokhsi, a pediatric endocrinologist at Children’s Nebraska.




Earline Edwards, a nurse practitioner in Children’s pediatric endocrinology clinic, said delaying onset by even a few years can make a big difference for young people.

“If you look at someone who is, say, 10, and you can delay it until they’re 13, 14, 15, that gets them through that tough adolescent period,” she said. “That’s a tough time, because they’re just trying to figure out who they are, let alone taking on the role of trying to manage diabetes.”

Meanwhile, Creighton University Medical Center-Bergan Mercy also has established protocols to treat adult patients using the therapy and plans to begin its first treatment later this month. For adults, officials said, screening for Type 1 diabetes and delaying the need for insulin gives patients and caregivers time to learn the skills needed to manage the disease, such as checking blood sugars and injecting insulin.

Gehring and Edwards, however, emphasized that the availability of the treatment also underscores importance of making people aware that it exists and of screening people with a family history of the disease, which often emerges in adolescence.

Children’s, Edwards said, now is a site for TrialNet, a network of healthcare providers and researchers that offers free Type 1 diabetes risk screening to people who have relatives diagnosed with the condition.

The screening, conducted by appointment with a health care provider or via in-home or laboratory test kits, is intended to catch the disease in its early stages, before symptoms appear. More information and a sign-up questionnaire are available on the network’s website, https://www.trialnet.org/our-research/risk-screening.

The Centers for Disease Control and Prevention estimated that 1.8 million Americans had Type 1 diabetes in 2021. According to TrialNet, the risk of developing the condition is about 1 in 300 for people with no family history of the disease. For those with a family member with Type 1 diabetes, the risk is one in 20, or 15 times higher.

Gehring said her family started participating in TrialNet after their youngest son was diagnosed. Richard tested positive for two diabetes-related autoantibodies, a sign his immune system had begun attacking the insulin-producing beta cells in his pancreas.

The treatment, an infusion given over the course of 14 days, is a monoclonal antibody that prevents T cells, a type of immune cell, from attacking. Currently, it’s approved for people who have two or more autoantibodies and are showing signs their bodies aren’t properly managing glucose.

Richard was enrolled in TrialNet’s Pathway to Prevention Study, which involved further monitoring to determine whether the disease was progressing. In January, he was found to be in Stage 2.

Richard’s doctor had also recommended monitoring his blood sugar for a time. The family had begun seeing spikes — not high ones, but they were there — in his blood sugar levels after meals, Gehring said.

That’s when Richard decided TZIELD might be worthwhile for him, she said. Before that, he thought he’d rather have diabetes. He was used to seeing his brothers manage the disease.

“His older brothers told him that he didn’t really know what he was asking for, that he should do it,” Gehring said. “He didn’t want diabetes, because they know what it’s like.”







Richard Gehring 1

Richard Gehring, 10, receives an infusion of a therapy shown to delay the onset of Type 1 diabetes by several years. That’s expected to buy him more time for kid stuff, without the extra tasks associated with managing the disease.




Richard stayed in Omaha with Seth Gehring during his treatment. The pair rented a house, and the rest of the family visited on weekends.

The price tag for the infusions is listed at just under $200,000. Joanna Gehring said it was covered by the family’s insurance. “We have good insurance,” she said. “We kind of have to.”

However, she noted that programs are available to help families who don’t have good coverage. Families also have the option of staying at the Carolyn Scott Rainbow House in Omaha, a guest house near 78th and Farnam Streets for out-of-town families who are coming to Children’s Nebraska from more than 90 miles outside of Omaha.

Gehring said Richard had no side effects from the treatment. He will continue to undergo periodic testing to check his blood sugar trends. That includes wearing a glucose monitor for a time before appointments. The perk of that is that he gets to carry a cellphone, which displays the results, when he wears the monitor.

“The things that matter to 10-year-olds,” she said.

For Richard’s parents and caregivers, however, the treatment also holds out hope that the time it buys him might produce additional advances that could further delay or even prevent the disease.

They’ve already witnessed significant medical advances in managing the disease. When Joanna Gehring’s teenage sons were diagnosed in 2011, she had to inject them with insulin. Now they wear continuous glucose monitors that communicate with insulin pumps that automatically deliver the hormone their bodies no longer produce on their own.

Gehring said researchers are discussing the possibility of repeating TZIELD, although that has not been approved. “In three years, there’s no telling what they might be able to do,” she said.

Said Edwards, “It’s just an exciting thing to see (that) we’re now at a point we have a therapy that can delay the onset of Type 1 diabetes. When we looked at this 20 years ago, we would never have dreamed we’d be where we are today.”



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