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Set Instant Pot to saute. Add the ground beef, garlic and onion and cook until meat is no longer pink; drain, if needed.
Add the diced tomatoes, tomato sauce, water, Worcestershire sauce, Italian seasoning, seasoned salt and elbow macaroni to the pot and mix well.
Place the cover on the pot and set timer to 4 minutes on high pressure (pressure cook setting). It will take the IP around 17 minutes to build up pressure before it begins cooking.
When cooking is done, do an immediate quick release and wait for the float valve to drop. Remove cover and serve immediately. Top with shredded cheese, if desired.