Around 9 million people live with diabetes mellitus (DM) in Germany. Around 500,000 new cases are documented every year. In addition, it must be assumed that there are at least 2 million unreported cases. The proportion of patients with type 2 DM is by far the highest and it is currently estimated that around 340,000 adults and 32,000 children are affected by type 1 DM [1]. People with diabetes have an increased mortality rate; however, this has decreased in recent years, particularly due to a reduction in cardiovascular mortality. "New" antidiabetic drugs have certainly played a relevant role in this. Various studies have shown that sodium-glucose Cotransporter 2 inhibitors (SGLT2 inhibitors) in particular but also glucagon-like peptide‑1 receptor agonists (GLP1-RA), have a significant benefit in patients with heart failure [2-5]. Surprisingly, this effect was also detectable in patients without DM [6]. Thus, the group of people who are treated with an SGLT2 inhibitor or a GLP1-RA has been expanded to include people who suffer from heart failure not associated with diabetes. This applies both to patients with reduced left ventricular systolic function (heart failure with reduced ejection fraction, HFrEF) and with preserved or mildly reduced systolic function (heart failure with preserved/mildly reduced ejection fraction, HFpEF/HFmrEF) [7]. In Germany heart failure is the most common diagnosis for hospitalization (40.6 cases/10,000 insurance years) and diseases of the cardiovascular system are the most common cause of death [8]. The increased risk of morbidity and mortality is also reflected in the perioperative setting.In addition to the risks posed by DM itself or associated diseases, the treatment with antidiabetic drugs can also lead to perioperative complications. This article focuses on the drug-related risks of the "new" antidiabetic drugs and draws conclusions regarding the management of anesthesia. The potentially life-threatening euglycemic diabetic ketoacidosis (eDKA) can be a perioperative side effect of SGLT2 inhibitors; however, the diagnosis is associated with hurdles. The GLP1-RAs are also increasingly being prescribed as they reduce cardiovascular risk and make weight loss much easier. GLP1-RAs delay gastric emptying, which potentially results in an increased risk of aspiration. In particular, if other risk factors for aspiration exist, patients should not be considered fasting, if the recommended break in GLP1‑RA intake has not been followed.
