[Perioperative Management of Long-term Antidiabetic Therapy in Patients with Diabetes Mellitus].

Drug therapy, as well as diabetes technology, e.g. insulin pumps or sensor glucose measurement, have developed enormously in recent years. Their use differs according to the type of diabetes, secondary or concomitant diseases, and individual factors and target values. In the perioperative phase, diabetic patients are generally at increased risk of complications, including a derailment of glucose metabolism, an increased rate of cardiovascular events, worsening of preexisting renal insufficiency, and increased incidence of wound infections. In addition, drug class-specific side effects of antidiabetic therapy may occur. The prevalence of diabetes patients in anesthesiology is high and will continue to increase. In Germany, more than 8 million people are estimated to live with diabetes mellitus. The rate of new cases is about 600 000 per year. The distinction between type 1 and type 2 diabetes mellitus is essential. Diabetes therapy is becoming increasingly individualized; combination therapies are becoming more common. Therefore, the management of long-term medication should also be individualized. Substance-specific side effects or adverse effects, especially of oral antidiabetic agents, must be considered in the care of patients, e.g. euglycemic diabetic ketoacidosis under SGLT-2 inhibitors is a relevant problem. Insulin therapy is also evolving; knowledge of new preparations and of insulin pump therapy facilitates perioperative management. Both hypoglycemia and hyperglycemia, possibly with ketoacidosis, must be avoided. The purpose of this article is to provide an overview of the management of long-term medication in patients with diabetes mellitus.