Place the sausage and the diced onion in a large skillet or cast iron skillet over medium high heat. Break up the meat and cook until the sausage is browned. Drain off any excess grease.
Stir in the diced tomatoes, Italian seasoning, salt, pepper, water and half and half.
Stir in the elbow macaroni. Bring the mixture to a boil, cover and reduce the heat to a low simmer.
Cover and stirring occasionally for 14-18 minutes until the pasta is tender.
Uncover and then remove the pan from the heat.
Stirring in the cheddar cheese and allow the heat from the meal to melt the cheese. Make sure to stir occasionally so the macaroni is covered with cheese. Serve while warm and enjoy.
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Notes
Refrigerate the leftovers in an air tight container for up to 5 days. You can easily make this recipe with ground beef or ground sausage if you prefer. We recommend shredding your own cheddar cheese for this recipe as it melts smoother and is more creamy.