WASHINGTON (AP) - Doctors now have proof that exercise and weight loss can dramatically cut millions of Americans' chances of getting diabetes - and it doesn't take a starvation diet or running a marathon.

``Every one of us can go out and walk 30 minutes each and every day and that's all it takes,'' Health and Human Services Secretary Tommy Thompson said in announcing the new findings Wednesday.

Walking and dropping, on average, 15 pounds helped people with a very high risk of getting the most common form of diabetes cut those odds by 58 percent, concluded the study by the National Institutes of Health.

For people who can't do that, a daily pill called metformin may be an option, the study also found. Metformin cut the diabetes risk by 31 percent - not nearly as effective as changing lifestyle and an option that does risk side effects. Still, it's the first medication ever proven protective against diabetes.

Some 10 million Americans are at very high risk of getting Type 2, or adult-onset, diabetes and could benefit from the findings - if only they knew they were at risk.

``We're not doomed to seeing this epidemic go on forever if we have the will, collectively, to implement these modest changes,'' said Dr. Allen Spiegel, director of NIH's National Institute of Diabetes and Digestive and Kidney Diseases.

Now the question is how to find all those people who need help. Diabetes screening is not routine. And even patients who know they're at risk aren't likely to get all the help the NIH's massive study offered: one-on-one diet advice, cooking classes, gym classes, support groups.

``We're going to need to rethink how we approach care and prevention,'' said Yale University's Dr. Robert Sherwin, past president of the American Diabetes Association.

So the ADA is teaming with government scientists to recommend the next steps, such as how Americans should be tested for their diabetes risk and whether health insurance should pay for any diet and exercise help.

Some 16 million Americans have diabetes, but experts say at least a third don't know it is silently festering in their bodies. It's a leading cause of blindness, kidney failure, limb amputations and heart disease. It kills 180,000 Americans annually, and costs the nation $100 billion in health bills each year.

Type 2 diabetes - where people gradually lose the ability to use insulin, a hormone crucial to converting glucose into energy - accounts for most cases. It's increasing at epidemic proportions as Americans get older, fatter and less active.

Risk factors include being over age 40; being overweight; being black, Hispanic or American Indian; and having diabetic relatives.

The NIH study enrolled 3,234 Americans who not only had those risk factors but also had an exam - the oral glucose tolerance test - that showed their bodies already weren't properly processing blood sugar. Almost half were minorities.

Fifty-eight percent who did moderate exercise for 150 minutes a week and lost 5 to 7 percent of their initial body weight staved off diabetes for at least the three years of the study.

The benefit was seen for every race and ethnicity. The oldest people, over 60, cut their risk most, by 71 percent.

How much work did it take? Most walked. They ate 1,200 to 1,800 calories a day. They cut fat consumption to 25 percent of daily calories, helped by such dietitians' tips as to choose baked chicken over fried and season vegetables with lemon, not butter.

``I was pretty much a couch potato,'' said Dianne Dunn, 48, of Washington, who lost 31 pounds during the study. ``When I walked up my block that first time I was huffing and puffing. Now I can walk 6 miles.''

Metformin cut risk by 31 percent and so is a second option, which could help people who physically can't exercise, said lead researcher Dr. David Nathan of Massachusetts General Hospital. No one knows if taking the daily pill plus diet and exercise would work better, because that wasn't studied. Also, metformin cannot be taken by people with kidney disease because of a rare but life-threatening side effect.

The Food and Drug Administration has approved metformin only as a diabetes treatment. Bristol-Myers Squibb, which sells it under the brand name Glucophage, is considering whether to seek FDA approval to market the drug as a way to prevent diabetes, too.

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