Background Over the past 10 years, more and more guideline developers and systematic review authors adopt the GRADE method. Also, many researchers and groups become interested in discussing, studying and developing it.

Methods We searched and analysed all GRADE papers published in academic journals from 2004 to 2012, abstracts in Cochrane colloquium from 2000 to 2012 and G-I-N Conferences from 2003 to 2012, attended GRADE workshops and meeting in GIN and Cochrane colloquium.

Results We found the following five major areas of research of GRADE system: 1. Comparison and Trend Analysis between GRADE and other different rating systems 2. Reasons analysis for downgrading and upgrading the quality of evidence and agreement test for different raters in systematic reviews 3. How to from evidence to recommendations in guidelines 4. Exploration of the application of GRADE in clinical stage (e.g. whether the guideline covers prevention, screening, assessment, treatment, rehabilitation or monitoring); Exploration of the application of GRADE in different areas such as public health, health policy and system. 5. The establishment and development of GRADE centre such as the Chinese GRADE centre and Spanish GRADE centre and how to promote the implementation of GRADE.

Conclusion As a new paradigm, the GRADE approach provides a comprehensive, explicit, and transparent methodology for grading the quality of evidence and strength of recommendations about the management of patients, however, GRADE is not a perfect system and still need to develop itself and been disseminated widely.