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Key Points Question What is the prevalence of hypertension and albuminuria in children and adolescents with type 2 diabetes? Findings This systematic review and meta-analysis of 60 studies found that 25% of children and adolescents with type 2 diabetes had hypertension and 22% had albuminuria. Pacific Islander and Indigenous youth had a higher risk of these conditions than children from other racial groups. Meaning In this study, the burden of hypertension and albuminuria in pediatric type 2 diabetes was substantial, especially among Pacific Islander and Indigenous youth., This systematic review and meta-analysis measures the prevalence of hypertension and albuminuria in pediatric patients with type 2 diabetes and evaluates the association of sex and race/ethnicity with these conditions., Importance Hypertension and albuminuria are markers of diabetes-related nephropathy and important factors associated with kidney outcomes in pediatric type 2 diabetes. However, their prevalence in these patients is unknown. Objective To measure the prevalence of hypertension and albuminuria in pediatric patients with type 2 diabetes and to evaluate the association of sex and race/ethnicity with these conditions. Data Sources MEDLINE, Embase, CINAHL, Cochrane Library, Web of Science, the gray literature, and references of the screened articles were searched for human studies from date of database inception to February 20, 2020. Study Selection Observational studies with at least 10 participants reporting the prevalence of hypertension and/or albuminuria in pediatric patients with type 2 diabetes were included. Three teams of 2 independent reviewers screened 7614 papers, of which 60 fulfilled the eligibility criteria. Data Extraction and Synthesis Three teams of 2 independent reviewers performed data extraction, risk of bias analysis, and level of evidence analyses. The meta-analysis was conducted using a random-effects model and followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Main Outcomes and Measures The primary outcomes included the pooled prevalence rates (percentages with 95% CI) for hypertension and albuminuria. The secondary outcomes assessed pooled prevalence rates by sex and racial/ethnic group. Results Sixty studies were included in the systematic review. Diabetes duration varied from inclusion at diagnosis to 15.0 years after diagnosis, and the reported mean age at diagnosis ranged from 6.5 to 21.0 years. Hypertension prevalence among 3463 participants was 25.33% (95% CI, 19.57%-31.53%). Male participants had higher hypertension risk than female participants (odds ratio [OR], 1.42 [95% CI, 1.10-1.83]), with Pacific Islander and Indigenous youth having the highest prevalence of all racial/ethnic groups (Pacific Islander youth: 26.71% [95% CI, 14.54%-40.72%]; Indigenous youth: 26.48% [95% CI, 17.34%-36.74%]; White youth: 20.95% [95% CI, 12.65%-30.57%]; African American youth: 19.04% [95% CI, 12.01%-27.23%]; Hispanic/Latino youth: 15.11% [95% CI, 6.56%-26.30%]; Asian youth: 18.37% [95% CI, 9.49%-29.23%]). Albuminuria prevalence among 2250 participants was 22.17% (95% CI, 17.34%-27.38%). Pacific Islander youth, Indigenous youth, and Asian youth had higher prevalence rates than White youth (Pacific Islander youth: 31.84% [95% CI, 11.90%-55.47%]; Indigenous youth: 24.27% [95% CI, 14.39%-35.73%]; Asian youth: 23.00% [95% CI, 18.85%-27.41%]; White youth: 12.59% [95% CI, 7.75%-18.33%]), with no sex differences (OR for male vs female participants, 0.68 [95% CI, 0.46-1.01]). Heterogeneity was high among studies, with a low to moderate risk of bias. Conclusions and Relevance In this study, markers of diabetes-related nephropathy were commonly detected in pediatric patients with type 2 diabetes, with a disproportionate burden noted among Pacific Islander and Indigenous youth. Personalized management strategies to target kidney outcomes are urgently needed in pediatric patients with type 2 diabetes to alleviate the burden of this condition on the kidneys.

Growth hormone deficiency (GHD) in children has significant impacts on growth and metabolism. Two-agent GH stimulation tests are commonly used to diagnose GHD, and these tests are generally considered safe. We report the case of a 5-year 5-month-old boy with a history of anaplastic ependymoma who underwent GH stimulation testing for growth deceleration using clonidine and arginine. He developed bilateral calf myalgia and gross hematuria within 24 hours of the tests. Myalgia and hematuria resolved spontaneously. Importantly, the literature review and database searches for hematuria identified 6 cases with clonidine and 20 cases with arginine. This case highlights an unusual combination of adverse reactions to clonidine and arginine in children undergoing GH stimulation testing to assess for GHD. Pediatric endocrinologists need to be aware of the potential for these side effects to allow appropriate management, and further studies are needed to clarify the mechanisms and frequency of these side effects. We recommend that patients and families need to be counselled about hematuria as an association of GH testing with these medications.

Janatani Balakumaran,*,1,2 Yun-Ya Kao,*,1,2 Kuan-Wen Wang,1,2 Gabriel M Ronen,1 James MacKillop,3 Lehana Thabane,1,4–7 M Constantine Samaan1,2,41Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; 2Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, Ontario, Canada; 3Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, Peter Boris Centre for Addictions Research, McMaster University/St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada; 4Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada; 5Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada; 6Centre for Evaluation of Medicines, St. Joseph’s Health Care, Hamilton, Ontario, Canada; 7Biostatistics Unit, St Joseph’s Healthcare-Hamilton, Hamilton, Ontario, CanadaCorrespondence: M Constantine SamaanDepartment of Pediatrics, McMaster University, Division of Pediatric Endocrinology, McMaster Children’s Hospital, 1280 Main Street West, HSC-3A57, Hamilton, Ontario L8S 4K1, CanadaTel +1 905 521 2100 ext. 75926Fax +1 905 308 7548Email samaanc@mcmaster.ca*These authors contributed equally to this workBackground: The obesity and Type 2 Diabetes Mellitus (T2DM) rates are at an all-time high globally. This diabesity epidemic is increasingly impacting children and adolescents, and there is scarce evidence of interventions with favourable long-term outcomes.Purpose: In order to understand the determinants of diabesity and how to address them, multiple stakeholders were invited to a meeting to discuss current state of knowledge and to help design a program to prevent pediatric and adolescent diabesity.Participants and methods: The meeting was held at McMaster University on March 4th, 2015. The event involved presentations to deliver state-of-the-art knowledge about diabesity, and roundtable discussions of several domains including nutrition, physical activity, sleep, and mental health. Discussion transcripts were analyzed using NVivo.Results: Forty-nine participants took part in the workshop. They included clinical healthcare professionals, public health, Aboriginal Patient Navigator, research scientists, students, and patients with family members. A total of 628 reference counts from the roundtable discussions were coded under 20 emerging themes. Participants believed that the most important elements of the program involve the provision of knowledge and education, family involvement, patient motivation, location of program delivery, and use of surveys and questionnaires for outcome measurement.Conclusion: Effective pediatric and adolescent diabesity prevention programs should be conceptualized by multidisciplinary stakeholders and embrace the complexity of diabesity with multiprong interventions. This meeting provided a framework for developing such interventions.Keywords: diabesity, meeting, pediatric, adolescent, obesity, pediatric type 2 diabetes mellitus

Milena Cioana,1,2 Devin Peterson,3 Paul Missiuna,3 Ron El-Hawary,4 Timothy Carey,5,6 Murray A Potter,7 Laura Banfield,8 Lehana Thabane,9–12 M Constantine Samaan1,2,9 1Department of Pediatrics, McMaster University, Hamilton, ON, Canada; 2Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada; 3Division of Orthopedics, Department of Surgery, McMaster University, Hamilton, ON, Canada; 4Orthopedic Surgery Department, IWK Children’s Health Center, Dalhousie University, Halifax, NS, Canada; 5Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; 6Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada; 7Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada; 8Health Sciences Library, McMaster University, Hamilton, ON, Canada; 9Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 10Department of Anesthesia, McMaster University, Hamilton, ON, Canada; 11Centre for Evaluation of Medicines, St Joseph’s Health Care, Hamilton, ON, Canada; 12Biostatistics Unit, St Joseph’s Healthcare-Hamilton, Hamilton, ON, Canada Abstract: In this report, we document the discussions and recommendations of a national conference designed to create a coalition to tackle adolescent idiopathic scoliosis (AIS) held on June 6 and 7, 2017 in Hamilton, ON, Canada. The goal of the establishment of this coalition is to join the efforts of patients, parents, physicians, researchers and other stakeholders to identify stakeholders’ perspectives and to categorize gaps in knowledge and target further AIS research and clinical care priorities. The participants’ main priorities included focus on shared decision making regarding clinical and research priorities between the stakeholders on the clinical, research and policy sides with patients and families. In addition, improvements in the dissemination of information via digital platforms and identification of cost-effective screening strategies that may help early identification and intervention were also recognized as a priority. Commitment was reached to form a national coalition to understand the determinants of this condition and enhance patient outcomes through improved clinical care and research efforts. Keywords: adolescent idiopathic scoliosis, childhood scoliosis, coalition, pediatric

E Danielle Sims,1–3 Sama Anvari,1,2,4,* Yung Lee,1,2,4,* Zainab Samaan,5 Laura Banfield,6 Lehana Thabane,1,7–10 M Constantine Samaan1–4,7 1Department of Pediatrics, McMaster University, Hamilton, ON, Canada; 2Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada; 3Medical Sciences Graduate Program, McMaster University, Hamilton, ON, Canada; 4Michael G. De Groote School of Medicine, McMaster University, Hamilton, ON, Canada; 5Department of Psychiatry and Neurobehavioral Sciences, McMaster University, Hamilton, ON, Canada; 6Health Sciences Library, McMaster University, Hamilton, ON, Canada; 7Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada; 8Department of Anesthesia, McMaster University, Hamilton, ON, Canada; 9Centre for Evaluation of Medicines, Hamilton, ON, Canada; 10Biostatistics Unit, St. Joseph’s Healthcare, Hamilton, ON, Canada *These authors contributed equally to this work Purpose: Several countries are legalizing the use of medicinal cannabis and easing restrictions on its recreational use. While adults have been the primary target of these initiatives, expanding access to cannabis will likely lead to increased use by children. While the effects of cannabis on pediatric neuropsychological and mental health outcomes have been broadly studied, there are limited data on the physical health effects of cannabis, including endocrine health. Animal studies have shown that chronic cannabis use leads to delayed sexual maturation; however, its effects on pubertal outcomes in children are not well studied. This systematic review aimed to assess the effect of cannabis use on pubertal timing and tempo in children.Methods: We conducted a systematic review with literature searches in MEDLINE, Embase, Cochrane Database of Systematic Reviews, Central, PsycINFO, CINAHL, Web of Science, and SPORTDiscus from inception to February 2018. A gray literature search was also completed in Clinicaltrials.gov and ProQuest Dissertations and Theses A&I. The primary outcome was pubertal timing, while secondary outcomes included pubertal tempo and final height and weight. We had no restrictions on date or language of publication of papers. Two reviewers independently assessed records for eligibility, with a third reviewer resolving disagreements.Results: Our database and gray literature searches identified 759 records. A total of 29 full-text papers were assessed for eligibility. However, all studies were ultimately excluded as they did not meet the eligibility criteria.Conclusion: Our results highlight a significant gap in existing literature regarding the effects of cannabis use on puberty. Adequately powered longitudinal studies are urgently needed to provide pediatricians and other health care providers with high-quality information on the potential effects of cannabis on the physical health of children.Prospective Registrar of Systematic Reviews Registration: PROSPERO no.: CRD42018089397. Keywords: marijuana, puberty, children, pediatric, tetrahydrocannabinol, cannabis