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Background Currently 60% of the United States population is overweight or obese. Recent data has shown that 7% of the US population has Diabetes Mellitus Type 2 and New Mexico is above the average at 9%. Many studies have shown that good glycemic control with lifestyle changes or Metformin therapy can prevent or delay microvascular and some macrovascular complications of Diabetes. These findings have not been translated into routine care especially in New Mexico in large part due to NMs largely, rural, poor and medically underserved population. The Extension for Community Healthcare Outcomes (ECHO) is a project developed at the University of New Mexico Health Science Center (UNMHSC) that connects UNMHSC expects with providers in rural New Mexico using a tele-health network. Although the ECHO project was first developed to treat Hepatitis C,its design allows it to be replicated for other complex and chronic diseases such as Diabetes Mellitus Type 2. We sought to evaluate the project as a teaching tool for medical students participating in rural education programs. We hypothesize that medical students participating in the diabetes ECHO project will demonstrate improved knowledge and a positive attitude towards the treatment and care for patients with diabetes. Methods A total number of 14 first through fourth year medical students were assigned to either an intervention group or control group. The intervention group completed four to eight weeks of the Extension for Community Healthcare Outcomes (ECHO) telehealth program on diabetes knowledge and attitude towards treatment while in a healthcare rotation in a rural New Mexico community. The control group completed four to eight weeks of a rural New Mexico rotation but did not participate in weekly tele-health clinics. Surveys rating the participants knowledge and attitude towards diabetes were given before and after the four to eight week clinics. Results There was at least one question with a significant change between the pre and post survey group that participated in the ECHO telehealth clinics in each survey. Two out of the thirty-three questions for the Diabetes Attitude Survey, one out of the seven for the Diabetes Knowledge Survey and, one out of the twelve questions for the Attitudes Diabetes Care Survey showed a significant change. There were no significant differences between the post survey intervention group compared to the post survey control group that did not participated in the ECHO telehealth clinics. Conclusions Although not statistically significant, the ECHO telehealth program showed improving attitudes and knowledge in treatment and understanding of type 2 diabetes mellitus.'