Purpose <p>Operable pancreatic cancer survivors with diabetes experience fatigue and engage less in diabetes self-management, which could lead to worse health-related outcomes. However, little is known about the impact of having both diseases on aspects of fatigue and diabetes self-management. This study aimed to compare characteristics of fatigue and diabetes self-management between operable pancreatic cancer (OPC) survivors with diabetes and people who have diabetes without OPC.</p> Methods <p>This is a cross-sectional study with a total of 207 participants with diabetes (57 OPC survivors and 150 without OPC). Fatigue and diabetes self-management were measured by the Fatigue Symptom Inventory and the Summary of Diabetes Self-Care Activities, respectively. Data were matched by age, gender, and diabetes treatment using propensity analysis. We used generalized estimating equations to compare the fatigue characteristics and diabetes self-management between the two groups.</p> Results <p>The final analysis included 98 participants with diabetes (49 OPC survivors and 49 without OPC) after propensity score matching. OPC survivors with diabetes perceived higher fatigue interference in general daily activities, work activities, and enjoyment of life and performed fewer diet and foot self-management compared to people who had diabetes without OPC.</p> Conclusions <p>OPC survivors with diabetes perceived more fatigue interference and engaged less in healthy eating and foot care. Future longitudinal studies should focus on examining the interplay between fatigue and diabetes self-management during the perioperative period.</p> Implications for Cancer Survivors <p>Future interventions addressing perceived fatigue interference and barriers to daily healthy eating and foot care are crucial for OPC survivors with diabetes.</p>