The weeklong low carb diet training program—titled Elevate Your Care: Low Carb Counseling for Healthcare Professionals—held its first five-day virtual course in May 2025, with a cohort of 13 physicians, pharmacists, nurses, and dietitians from across the collaborative. The training program was developed by a team of MCT2D experts, with leadership from Rina Hisamatsu, RDN, MPH, lead dietitian.
NEWS & EVENTS 
SPECIALTY CARE
Meeting an Unmet Need in Type 2 Diabetes Care
The American Diabetes Association’s 2025 Standards of Care emphasize that individualized medical nutrition therapy (MNT) is an essential component of diabetes care, with low carbohydrate diets (LCD) being one effective approach that is growing in popularity and interest among patients. The Michigan Collaborative for Type 2 Diabetes (MCT2D) is aligned with the ADA. As one of its core quality initiatives, the Michigan Collaborative for Type 2 Diabetes (MCT2D) aims to promote low-carbohydrate eating patterns and to support our participating practices in improving their T2D care.
Primary care teams across our collaborative are motivated to improve and align with ADA standards, however, many clinicians report uncertainty in how to safely discuss and implement low-carb counseling with patients.
To address this gap, MCT2D developed a novel training program combining evidence-based instruction, empathy-driven exercises, and an AI-powered patient simulator for primary care teams interested in strengthening their low carb counseling for patients with type 2 diabetes.
The training program was developed and led by an interprofessional team of MCT2D experts and was led by Rina Hisamatsu, RDN, MPH, lead dietitian for MCT2D.
“There was a lot of interest and demand from the collaborative for more hands-on training related to low carb nutrition counseling. That was really the only information we started with. And it was like, ‘What can we do [to support them]? it was a blank canvas where anything can happen.”
- Rina Hisamatsu, RDN, MPH, lead dietitian and creator of MCT2D's low carb counseling training program for clinicians
Rather than rush into content development, Rina and the team first focused on learning best practices in course design. She reached out to experts across the University of Michigan, including the Center for Interprofessional Education, Center for Research on Learning and Teaching, and the Center for Academic Innovation, to learn what makes an effective professional education program.
Designing with Intention
The course was developed with guidance from obesity medicine specialists, Dina Griauzde, MD, MSc, Dipl. ABOM and Jonathan Gabison, MD, FAAFP, DABOM.
Dr. Griauzde is an Assistant Professor in the Department of Internal Medicine at the University of Michigan. She also serves as Research Director of the Michigan Medicine Weight Navigation Program and Co-Medical Director at the VA Ann Arbor’s Weight Management and Metabolic Health Program. Dr. Gabison is an Assistant Professor in the Department of Family Medicine at the University of Michigan. Both physicians serve as content experts for MCT2D.
Rina also drew on the expertise of seasoned low carb diet educator Stacey Pilarz, RDN, CDCES, of the Michigan Interdisciplinary Clinic for Obesity and Reproduction. Together, the team provided live lectures and interactive take-home assignments.
The workshop was designed around five 1-hour interactive sessions and supplemented with creative take-home assignments. It was tailored to help clinicians:
- Understand the foundations and science of low carb eating patterns
- Build confidence in recommending low carb diets
- Learn how to tailor recommendations to individual patient needs
- Explore ways to implement counseling into workflows, including group visit formats
An initial survey helped gather input from interested practices on format preferences, learning needs, and existing workflows. This informed everything from scheduling to session topics.
A Workshop Built for the Real World
The final workshop blended synchronous Zoom-based learning with hands-on practice. Take-home assignments were a highlight:
- Food logging and carb tracking: Participants tracked their own meals to understand the patient perspective.
- Myth-busting: Clinicians read and reflected on common misconceptions about low carb diets.
- Two-minute pitch challenge: Participants crafted and shared concise messages about low carb eating—ideal for time-limited clinic visits.
- Low carb day challenge: Clinicians attempted a one-day low carb diet to experience the practicalities and hurdles their patients might face.
“Keeping track of food intake gave participants insight into the effort it takes to follow nutrition guidance,” Rina says. “It helped many reflect on what they ask of patients—and how they can make it more manageable.”
- Simulated counseling with an AI chatbot: Built by Elliott Brannon, MD, PhD, then a medical student at the University of Michigan and now a family medicine resident, this innovative tool allowed clinicians to practice conversations with virtual patients.
The LCD Patient Simulator: AI in Action
A standout feature of the workshop was the AI-enabled “LCD Patient Simulator,” developed Dr. Brannon.
“I had developed a similar chatbot for the Washtenaw County Department of Health and had worked with [MCT2D Program Director] Dr. Oshman during medical school,” Brannon explained. “She asked if I could develop a chatbot for MCT2D, and I set up a meeting with Rina and the team to discuss.”
Built with OpenAI technology, the simulator featured six virtual patients with diverse cultural backgrounds and varying levels of health literacy. Clinicians practiced motivational interviewing, dietary counseling, and individualized care planning—and could type “Feedback” to receive real-time reflections on their communication style.
“Perhaps the most difficult part of developing the chatbot was figuring out the ‘personality’ of it,” Brannon said. “I developed six different chatbots with different levels of knowledge, interest, and health literacy.”
Participants found the chatbot engaging and realistic, rating it 4.4 out of 5 for usefulness in improving their counseling skills and 4.5 out of 5 for user-friendliness. Funding to develop the LCD Patient Simulator project came from the Blue Cross Blue Shield of Michigan Foundation Student Award Program.
As Hisamatsu reflected, “People really liked that tool as a learning experience for clinicians,” though she noted that future versions will include “patients who are maybe a little bit more resistant to change” to mirror real-life encounters.
Collaboration Made it Stronger
Rina is quick to credit the team behind the scenes, including guest speakers and content contributors from across MCT2D.
Each session featured a different expert, including physicians, registered dietitians, care navigators, and motivational interviewing specialists. The final session focused on empathy and relationship-building, with mock videos showing how clinicians can use motivational interviewing (MI) techniques to support behavior change.
“We didn’t want participants to leave as MI experts—but to understand the heart of it: empathy, listening, meeting patients where they are," said Hisamatsu.
What’s Next
With overwhelmingly positive feedback from the pilot cohort, Rina sees a bright future for the workshop.
“My hope is this won’t be a one-and-done. We want to refine the course, offer it regularly, and potentially create specialized versions for different clinician types.”
In October 2025, Rina and her team offered a second instance of the course, with three days of targeted instruction to a cohort of registered dietitians from across the MCT2D collaborative. Coming up in December, Rina and the MCT2D team will present a robust evaluation of the low carb diet clinician training program at the Institute for Healthcare Improvement (IHI) Forum, convening in Anaheim, CA.
Rina is driven to train and support as many MCT2D members as possible. “We want this to grow with our collaborative—so every clinician feels confident talking about nutrition with their patients.”
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Support for The Michigan Collaborative for Type 2 Diabetes (MCT2D) is provided by Blue Cross Blue Shield of Michigan as part of the BCBSM Value Partnerships program.
Although Blue Cross Blue Shield of Michigan and MCT2D work collaboratively, the opinions, beliefs and viewpoints expressed by the author do not necessarily reflect the opinions, beliefs and viewpoints of BCBSM or any of its employees.