<p>Patients with diabetes mellitus who undergo major vascular surgical interventions, have an increased risk of complications, such as metabolic derailment, postoperative cardiovascular events, wound infections and cognitive dysfunction. These have an influence on the duration of the hospital stay, the quality of life and the 1‑year mortality. Therefore, glycemic control during the whole hospital stay is of crucial importance. Furthermore, perioperative factors, such as blood pressure fluctuations and the extent of the perioperative inflammatory reaction can negatively influence the glucose metabolism due to the elevated stress reaction. An extended forward-looking perioperative management of these highly vulnerable patients with an early risk stratification, optimization and strategy planning, the so-called early risk stratification and strategy (ERSAS) concept, represents a measure to reduce the risk of complications after vascular surgical interventions in patients with diabetes mellitus. The treatment of diabetes mellitus has undergone a rapid development in recent years due to medicinal and technical innovations. Accordingly, these innovations should be taken into consideration in perioperative risk stratification and strategy planning. This review article describes the perioperative management employing the ERSAS concept for risk reduction of postoperative complications in vascular surgery patients with diabetes mellitus. This provides the possibility to establish an intersectoral, interdisciplinary and interprofessional patient-oriented level of treatment.</p>