Among patients with poorly controlled T2DM, it is often not clear whether the problem is attributable to the healthcare provider’s failure to appropriately intensify therapy, the patient’s non-adherence to prescribed medications, patients’ unwillingness to accept new treatments or a combination of these factors. Shared decision making (SDM) and patient cognitive behavioral interviewing are two strategies found in the literature to have a positive impact on patient adherence. The ENGAGE trial is a pragmatic randomized trial of 1,400 patients on least one oral hypoglycemic therapy with poorly controlled disease to test the impact of combining shared decision making and behavioral interviewing intervention, providing both discrete decision support and ongoing motivational support to encourage medication adherence. The trial further proposes to examine the intervention using a screening tool that describes patients’ readiness to change their medication behaviors. The telephonic counselor-based intervention is scalable to many patients, comparatively inexpensive, and does not require creating an infrastructure to share patients’ medication adherence information with patient’s physicians.