Long term type 2 diabetic here too (20 years). I take a lot of pills (Byetta too), but they do their job, I know what each one does, and have copies of my lab work to back it up. There's a risk with taking meds, but without them, I'd probably be dead already, or be blind and in constant pain, which to me is worse. With them, so far, no complications at all. If there was any way to clone my doc, I'd want every diabetic in the world to see her.
What choices do doctors have? Education, medication, and for some things, surgery. Education has to come first - what lifestyle changes can help? are you willing to do them? what are your medication choices? side effects? We're dealing with the human body here; it's complicated, and not everyone reacts the same way. And the doctor may have 10-15 minutes to decide, for you or with you, what's the best balance. So many patients are passive about their own care (and probably many doctors don't want questioning patients either).
The news deals with soundbites, and while 43% rise in heart attacks sounds like a lot, it was a tiny percentage of people who had heart attacks. I think a lot of people will be switched to Actos, though. Same family of drugs, just no evidence of increased heart attacks (yet).
Any of the drugs in this family can cause an increase in water retention, so people can gain weight (and can't this cause breathing problems?) If the patient was formerly "out of control" and spilling sugar in the urine, the new control will cause that sugar to be stored instead of lost, so that can cause weight gain as well.
Byetta's wonderful (to me) because it really killed my formerly constant hunger. It's only been on the market a couple of years, so I'm waiting for its long term side effects to pop up...