Background: Clinical care for type 2 diabetes has improved, but remains suboptimal. Collaborative, team-based models that maximize the skills of different disciplines may improve care for type 2 diabetes, but few have been tested using rigorous research designs.

Objective: We investigated the effectiveness of a registered dietitian nutritionist-led (RDN) telemedicine program vs. usual care on type 2 diabetes optimal care goals, including A1C, blood pressure, tobacco use, and appropriate statin and aspirin use. For participants randomly assigned to the intervention group, RDNs utilized an approved treatment protocol to initiate/titrate therapies for blood glucose, hypertension and lipids, in addition to providing medical nutrition therapy. Outcomes were compared between the intervention vs. usual care group over one year.

Design: A randomized control trial design was used that included 118 adults with type 2 diabetes who were receiving care at two rural primary care clinics. Participants were randomized (March-December 2016) to usual (clinical) care or an intervention group that included usual care plus monthly RDN-led telemedicine visits for one year.

Results: Mixed model regression was used to examine outcomes between baseline and one year follow-up. Modest, but significantly greater improvement was observed for the intervention group in the number of optimal care measures met at follow-up, 3.7 compared to 3.2 among controls (p=.017) after adjusting for baseline. Among individual optimal care measures, the intervention group had a significantly greater increase in medication use, with 2.5 and 2.2 higher odds (compared to controls) of taking a statin and aspirin as appropriate, respectively.

Conclusions: The ENHANCED study care model, which utilized RDNs to initiate and titrate medications, modestly improved type 2 diabetes care outcomes for adults.


G. Benson: None. A. Sidebottom: None. J. Hayes: None. J.L. Boucher: None. M. Vacquier: None. M.D. Miedema: None. A. Sillah: None. J. VanWormer: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at