Background <p>Diabetes prevention efforts involve lifestyle changes and, increasingly, stress reduction efforts. However, we lack a measure to assess the stress associated with living with prediabetes, a high-risk state of type 2 diabetes. We developed a novel scale, the Prediabetes-Related Stress Scale (PRSS) and assessed the reliability and validity of the newly developed scale among Latino adults in the United States (US).</p> Methods <p>Conducted a cross-sectional study from December 2024 to March 2025 with English and Spanish speaking Latino adults (18 + years old) in the US (<i>n</i> = 442) at elevated risk of type 2 diabetes. We used exploratory factor analysis (EFA) to examine factor structure, reliability testing, convergent validity, and measurement invariance testing for English and Spanish versions of the PRSS.</p> Results <p>Participants’ mean age was 46 years old, 54% responded in English, and 57% were women. EFA results supported scale reduction from 29 items to 21 items, and a three-factor model. Reliability was excellent (composite reliability = 0.95). Model fit was appropriate. Convergent validity was achieved between PRSS, acute stress (<i>r</i> = 0.50), and psychological distress (<i>r</i> = 0.65). Configural and metric invariance were achieved across language, however, scalar invariance evidence was mixed.</p> Conclusions <p>This study provides preliminary evidence of the validity and reliability of a newly developed scale focused on prediabetes-related stress. Further validation and use of the PRSS can support the person-centered care that considers patient needs and preferences to guide clinical decisions and reduce diabetes disparities.</p>