About one in four Veterans lives with type 2 diabetes (T2D) — a rate nearly three times the general population, and about one quarter of pharmacy spend for Veterans is related to diabetes medications and supplies. The Veterans Health Administration partnered with Virta Health to provide ketogenic telehealth services for Veterans with T2D. Previously published outcomes show significant improvements in HbA1c, BMI, diabetes medications and cost, and outpatient visits in the first five-months, but long term durability of outcomes across the population and within subgroups is critical to positively impact diabetes care. This retrospective, real-world analysis assessed the effects of the ketogenic telehealth service on glycemia, diabetes medications, and body weight over two years in people with T2D who were prescribed an antihyperglycemic medication other than metformin, using medical record data and further explored effects according to self-reported race and ethnicity as well as geographical factors such as socioeconomic deprivation and rurality. Upon initiation of carbohydrate restricted nutrition therapy such as a ketogenic diet, blood glucose rapidly declines, necessitating dose reductions and eliminations of drugs associated with hypoglycemia that are managed by licensed medical providers in anticipation of and in response to daily blood glucose and ketone concentrations. Deprescription of other medications can occur after lower blood glucose due to nutritional changes has been sustained. Retention in this lifestyle therapy was high with 244 of 425 (57.4%) remaining under care after two years. Veterans under care for two years significantly improved HbA1c by 0.6±1.7% from 8.1±1.5% and the number of diabetes medications per patient reduced by 0.8 from 2.4, with the group requiring 43% fewer antihyperglycemic medications beyond metformin. In addition, patients sustained 7.5% weight loss from 241 pounds at time of enrollment in the clinic. Type 2 diabetes reversal within the group was evident in that the proportion of patients with HbA1c≥9% was reduced by over 40%, and despite starting on antihyperglycemic medication other than metformin, reversal to the point of drug-free T2D remission was observed in 7% of patients. Subgroup analysis by race and ethnicity, area deprivation index as a marker of a geographical area’s level of socioeconomic disadvantage, and urban versus rural and highly rural areas identified no significant differences between groups in the therapy’s effect on HbA1c, medications, and weight loss. Results from this real world analysis suggest that ketogenic telehealth services for T2D can effectively be utilized as an adjunct to care within the VA health system to improve blood glucose and body weight while reducing dependence on antihyperglycemic medication and provide Veterans an opportunity for T2D reversal and remission nationwide across races, ethnicities, and various levels of rurality and socioeconomic disadvantage.