Background: Diabetes can pose challenges when using adjuvant chemotherapy (AC), as specific cytotoxic drugs, including oxaliplatin, may potentiate certain diabetic complications, such as neuropathy. We performed a provincial analysis of resected colon cancer patients to evaluate the prevalence of diabetes, type of chemotherapy used, and survival outcomes. Methods: We examined 5,440 patients with resected stage 2 or 3 colon cancer who were diagnosed from 2004 to 2015 in Alberta. Baseline patient, tumor, and treatment characteristics were compared between those with and without diabetes. Survival analysis was conducted based on Kaplan-Meier methods. Results: 608 patients (11%) had uncomplicated diabetes (UDM) and 436 (8%) patients had diabetes with complications (CDM), defined as neuropathy or other micro/macrovascular end-organ damage. CDM patients were older and had worse Charlson comorbidity index (p < 0.001). While 34% of UDM patients and 35% of non-diabetic patients received AC, only 15% of CDM patients received AC (p < 0.001). Among those who received AC (N = 1574), an oxaliplatin-based regimen was given to 45% and 52% of UDM and non-diabetic patients, respectively, but only 35% of CDM patients (p < 0.001). Kaplan-Meier analysis revealed significantly worse overall survival (OS) in the CDM group when compared to the UDM or non-diabetic groups (p < 0.001). Of those treated with AC however, there were no statistical differences in OS (p = 0.188) or cancer-specific survival (CSS) (p = 0.461) across all groups regardless of diabetes or complication status (see Table). Receipt of oxaliplatin was associated with improved OS among patients with stage 3 disease compared to monotherapy (p = 0.006). Conclusions: Patients with CDM are less likely to receive AC; however, patients treated with oxaliplatin-AC appear to have similar survival outcomes as their UDM and non-diabetic counterparts.