OBJECTIVES: Treatment guidelines propose stepwise approach for type II diabetes management: metformin (Met) as first, Met + SUs or other oral antidiabetic agents (i.e. DPP4s) or insulin as second or third line. Despite this evidence based line treatment, DPP4s prescriptions in Turkey can be initiated only by endocrinology or internal medicine specialists working on tertiary care since March 2010 to control DM treatment budget. This access restriction may naturally cause prescription shifts to non-restricted treatment options such as insulins. This research’s objective is comparing yearly usage ratio of insulins and DPP4s in Turkey and 5 European Turkey’s price reference countries. METHODS: Sales as international units(IU) and value between 2010-2014 are obtained from IMS Dataview7.  Yearly total insulin vs. DPP4s as IU/SU and US$ sales is compared between Turkey and France, Greece, Italy, Portugal, Spain.  RESULTS: Insulin to DPP4s utilization ratio in Turkey(183) is 4,6 times higher than reference countries’ average (40) in 2014.  Compared to 5 EU countries, total insulin to DPP4s utilization ratio is consistently the highest (540 in 2010 and 183 in 2014) in Turkey between 2010-2014.  As value sales, the highest ratio of total insulin to DPP4s is in Turkey (7,2), followed by Italy(2,9) and France(1,3). In Portugal, Spain and Greece this ratio is below one, indicating higher DPP4 value sales compared to insulins. Reversed ratio of insulin to DPP4s in Turkey is also present between 2010-2013. CONCLUSIONS: Turkey has the highest insulin to DPP4 ratio over five years among other countries. DPP4s access restriction might have caused early and disproportionate insulinization of patients. From health policy perspective, implementation of access restriction might have led cost reduction in the short run, however it may cause greater burden due to shifts to later treatment lines.