Purpose <p>The purpose of the study was to describe the type and number of symptoms and examine symptom clusters of breast cancer survivors (BCS) with diabetes (type 2) by glycemic control (HbA1c &lt; 7 or ≥ 7%).</p> Methods <p>A retrospective cohort study was conducted. Symptom data were extracted from clinical notes in the electronic health record. BCS (stage I-III) diagnosed between 2007 and 2019 had diabetes, and at least one HbA1c within 8&#xa0;months of initial chemotherapy was included. Zero-inflated negative binomial regression analysis was used to examine total symptoms by glycemic control. Exploratory factor analysis was conducted to identify symptom clusters.</p> Results <p>Three hundred twenty-seven BCS met the inclusion criteria. Two symptom clusters were identified in BCS with HbA1c ≥ 7%: a psychoneurological cluster (anxiety, fatigue, peripheral neuropathy, and depression) and a gastrointestinal cluster (vomiting, nausea, and constipation). Two symptom clusters were identified in BCS with HbA1c &lt; 7% a mixed gastrointestinal/psychoneurological cluster (vomiting, nausea, peripheral neuropathy, fatigue, and constipation) and a mental health symptom cluster (depression and anxiety).</p> Conclusion <p>The symptom clusters of BCS differed by glycemic control. Prospective research studies are needed to examine the role of glycemic control in symptoms in BCS with diabetes. Understanding the influence of glycemic control can help providers identify BCS at high risk for troublesome symptoms and symptom clusters, thereby facilitating interventions that target glycemic control, potentially mitigating symptoms, and symptom clusters, and improving outcomes for BCS with diabetes.</p>