Key PointsQuestionIs there an association between spousal diabetes status, ideal cardiovascular health metrics, and incident diabetes?FindingsIn this cohort study with 34 821 Chinese adults, spousal diabetes status with uncontrolled glycated hemoglobin level was independently associated with increased risk of incident diabetes. Achievement of ideal cardiovascular health metrics attenuated this risk.MeaningThese findings suggest the potential benefit of couple-based lifestyle or pharmaceutical interventions for diabetes.