Diabetes is a chronic condition that affects both members of a couple. However, relatively few studies have focused on the entire couple system as the unit of observation when examining the psychosocial impact of this disease. This narrative review examines the literature between 1980 and 2010 that uses the couple as the unit of observation. A total of 49 articles were identified for review. Articles were grouped by their central themes or outcomes: (1) sexual functioning, (2) relationship adjustment and support, (3) culture and spirituality, (4) treatment/education programs, and (5) diabetes as a risk factor. Research and clinical implications such as increasing the utilization of dyadic analytical strategies and the importance of assessing illness burden from each partners' perspective are discussed. Identified benefits of incorporating the couple dyad for future research and clinical practice included: (1) understanding the influence of variables such as a non-diabetic partner and gender have on diabetes adjustment and management, (2) the role disease severity and management of diabetes by the partner living with diabetes has on spousal support and non-diabetic partner emotional wellbeing, (3) the interdependent nature of couple outcomes in the areas of adjustment to sexual dysfunction, perceived illness burden, and couple satisfaction, as well as, (4) disease as both an individual and a shared experience among couples. [ABSTRACT FROM AUTHOR]