Sodium-glucose cotransporter-2 inhibitors (SLGT-2is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) are evidence-based medications that reduce morbidity and mortality for individuals with diabetes but remain significantly underused. Diffusion of responsibility in prescribing across multiple providers and a burdensome prescribing process are barriers to their optimal use. This three-arm randomized pragmatic trial conducted at Massachusetts General Hospital involved 191 primary care providers and 1,389 patients. It tested the impact of an intervention to target diffusion of responsibility with and without additional reduction in prescribing burden on SGLT-2i and GLP-1RA prescribing compared to usual care. It also identified characteristics of patients, providers, and their interactions to understand for whom each intervention would be most beneficial.