In Australia, approximately 5.1% (i.e., over 1.3 million) of individuals have been diagnosed with any type of diabetes (excluding gestational diabetes) (1) and 16.7% (>2 million) over the age of 25 have possible or ‘pre-diabetes’ (2). We previously conducted a pragmatic cluster randomised controlled trial, the Healthy Rural Hearts trial (HealthyRHearts) (3), in primary care practices within a large rural region categorised as Modified Monash Model (MMM) regions 3-5 in NSW, Australia. The HealthyRHearts RCT evaluated the impact of providing medical nutrition therapy (MNT) by Accredited Practising Dietitians (APD) via telehealth, versus usual GP care on CVD risk factors in rural adults screened by their GP as being at moderate-to-high CVD risk. It found that providing two hours of MNT delivered by APDs via telehealth achieved significantly greater improvement in diet quality, body weight and HbA1C with similar change in lipids, with benefits continuing to 12-months. Given that less that half the sample has pre-existing diabetes, this secondary analysis sought to evaluate diabetes-related outcomes at 12 months in adults enrolled in HealthyRHearts who received telehealth MNT compared to usual GP care. This secondary analysis used a subsample of participants (n = 81, n = 56 intervention, n = 25 control) with diagnosed or possible diabetes from the HealthyRHearts cluster RCT. ‘Diagnosed’ diabetes was reported by a primary care physicians, while ‘possible diabetes’ was defined from a baseline fasting blood glucose level [FBG] ≥ 5.5 mmol/L or HbA1c ≥ 6.0%). The intervention group received five telehealth-based MNT sessions over six-months and up to four personalised nutrition reports. Both control (n = 7 primary care practices) and intervention groups (n = 9 primary care practices) received usual care from their general practitioner. Within and between group changes in FBG and HbA1c were calculated from baseline up to12-months using Bayesian hierarchical regression models. Results indicated that participants in the intervention group showed greater reductions in FBG (-0.43 mmol/L, 95% CrI [-1.05, 0.19]) and Hba1c (-0.26% 95% CrI [-0.51, -0.00]) compared to controls at 12 months, when accounting for medication. The Bayes Factor indicated strong evidence of a greater reduction in FBG in the intervention group (10.64) and very strong evidence for HbA1c (39.45), supporting these findings. Current results indicate that MNT delivered via telehealth supports improvement in blood glucose variables in individuals with diagnosed diabetes and possible or pre-diabetes. A key strength of this study is that it captured diabetes care offered by primary care in rural areas of Australia, where access to services may be limited. Importantly, it tested the impact of MNT using a rigorous clustered RCT design in a pragmatic, real-world setting and hard-to-reach population. Future studies with larger sample sizes are needed to confirm these findings in similar populations.